Case of fulminant leptospirosis in a renal transplant patient

Abstract

We present a case of fulminant leptospirosis that was acquired in the suburban area by a 48-year-old male renal transplant recipient. He developed acute renal and hepatic failure with profound jaundice. Spirochetes were identified on liver biopsy. Weil's disease was suspected, and the diagnosis was further supported by a positive serum Leptospira interrogans icterohaemorrhagiae antibody titer. Unfortunately, he suffered from recurrent lower gastrointestinal bleeding, had a prolonged hospital course, and eventually succumbed to overwhelming sepsis. This case is the third report to our knowledge of leptospirosis in a renal transplant recipient in the English literature.

A first report of leptospirosis after liver transplantation

“…Only 4 case reports of leptospirosis after solid organ transplantation have been published to date, all of which occurred in kidney transplant recipients (2)(3)(4)(5). This is the first report of leptospirosis in a liver transplant recipient, to our knowledge.…”

“…The published case reports are summarized in Table , including the present case. All cases presented with Weil's disease, and no patient presented with pulmonary hemorrhage.…”

Pet safety guidelines for pediatric transplant recipients

“…Typical symptoms in humans include fever, headache, jaundice, anorexia, myalgias, abdominal pain, vomiting, and uveitis 30 . Due to limited reports in the literature, with most being outside of the United States, the risk of leptospirosis in transplant recipients is unclear 41–43 …”

“…30 Due to limited reports in the literature, with most being outside of the United States, the risk of leptospirosis in transplant recipients is unclear. [41][42][43]…”

Leptospirosis in Humans and Dogs

“…In humans the clinical manifestations and severity of leptospirosis vary from a flu-like illness to severe renal and hepatic failure, myocarditis, hemorrhage and death, depending on the concentration of the inoculum, the virulence of the infecting serovar, the susceptibility of the host, and the affected organ or systems [27]. Two cases of the disease have been recorded in patients transplanted with kidneys infected with Leptospira, one of them fatal [28,29]. Is characterized by two phases, the first bacteraemic or leptospirémic, has an abrupt onset of duration seven to ten days, the signs and symptoms are not pathognomonic, they can easily be confused with other infectious processes of bacterial type or viral, such as dengue, zika, chincungunya, malaria, brucellosis, rickettsiosis.…”