A case of Weil's syndrome developing steroid resistant immune haemolytic anaemia

Abstract

Weil's syndrome is known in a serious clinical form, but the development of immune haemolytic anaemia related to Leptospira in human beings is a very rare clinical presentation, and we encountered only 1 case report in a literature scan. In this paper we present a case of Weil's syndrome in which immune haemolytic anaemia findings, and haemolysis could only be controlled by intravenous immunoglobulin (IvIg) treatment.

Haemolytic anaemia and bilateral uveitis associated with leptospirosis in a 6‐year‐old Quarter Horse gelding

“…Immunemediated haemolytic anaemia can be associated with systemic infection, such as leptospirosis in this case, through the theory of molecular mimicry where there is antibody cross-reaction between epitopes present on infectious agents and autoantigens, as expressed on red blood cells (Nassiri et al 2005;Tizard 2013;Carlson 2015b). Immunemediated haemolytic anaemia associated with leptospirosis infection has been previously reported in other species including cattle, sheep and man (Decker et al 1970;Smith and Armstrong 1975;Solmazgul et al 2005;Nassiri et al 2011).…”

“…; Smith and Armstrong ; Solmazgul et al . ; Nassiri et al . ), drugs (penicillin or trimethoprim sulfonamide), or neoplasia (Weiss and Moritz ; Aleman ; Carlson ,b).…”

“…Differentials for acute anterior uveitis with systemic inflammation included Streptococcus equi subspecies equi metastatic abscessation, leptospirosis, equine infectious anaemia virus, equine viral arteritis virus, equine influenza virus, equine herpesvirus-1, Brucella spp., E. coli, septicaemia, such as that associated with Salmonella infection, systemic immune-mediated response, such as IMHA and much less likely Borrelia burgdorferi due to the geographic area not being endemic for Lyme disease and Rhodococcus equi based on his age (Neil et al 2010;Hollingsworth 2011;Priest et al 2012). Differentials for IMHA included primary IMHA or secondary to infectious aetiologies including equine infectious anaemia, Clostridium perfringen, and leptospirosis as described in other species (Decker et al 1970;Smith and Armstrong 1975;Solmazgul et al 2005;Nassiri et al 2011), drugs (penicillin or trimethoprim sulfonamide), or neoplasia (Weiss and Moritz 2003;Aleman 2015;Carlson 2015a,b). Thoracic ultrasound revealed mild comet tails present cranioventrally bilaterally and abdominal ultrasound revealed no abnormalities.…”

Bovine immune‐mediated hemolytic anemia: 13 cases (November 2008–August 2009)

“…In leptospirosis, the presence of anti‐RBC antibodies and RBCs first sensitized with leptospiral antigens and then lysed by anti‐leptospiral antibody and complement have been suggested as mechanisms of RBC lysis . The development of Leptospira ‐related IMHA has also been reported in people . Finally, 3 distinct mechanisms suggested to explain drug‐induced IMHA are the formation of antibodies to the drug, acting as haptens that attach to the RBC membrane; binding of preformed drug‐antibody complex to the RBC membrane; and induction of a true autoantibody .…”

Leptospirosis and immune‐mediated haemolytic anaemia in a dog

“…It also occurs occasionally in humans (Trowbridge and others 1981, Solmazgul and others 2005, Zschiedrich and Fischer 2010) and has been suspected in two black rhinoceros (Douglass and Plue 1980). Haemolysis associated with leptospirosis may be due to immune-mediated mechanisms triggered by the leptospirosis infection, or it may be due to the production of haemolysins by the Leptospira .…”