Desmopressin Therapy for Massive Hemoptysis Associated with Severe Leptospirosis

Abstract

Massive hemoptysis in patients with severe leptospirosis is often resistant to conventional therapies and can rapidly become fatal. Desmopressin is a fast-acting blood-saving agent used in various hereditary and acquired clotting disorders. We used desmopressin infusions to treat massive pulmonary hemorrhage in six leptospirosis patients with respiratory failure, shock, and multiple organ dysfunction. Hemoptysis ceased rapidly in every case, and five patients finally recovered. Two additional patients with less severe hemoptysis were also successfully treated.

Leptospirosis: a case report of a patient with pulmonary haemorrhage successfully managed with extra corporeal membrane oxygenation

“…This has led to recent reports of novel approaches to treatment including the use of inhaled nitric oxide 17 and desmopressin. 18 Neither of these options were used in our case. Instead the patient was successfully supported through the period of pulmonary haemorrhage by the use of ECMO.…”

An Uncommon Cause of Diffuse Alveolar Haemorrhage

“…Hypoxaemia is sometimes resistant to mechanical ventilation, whose settings must be the same as for acute respiratory distress syndrome ADRS [5] . In a series of 6 cases, desmopressin seems to have improved survival by its haemostatic effect [13] .…”

Acute Respiratory Distress Syndrome Manifested by Leptospirosis Successfully Teated by Extracorporeal Membrane Oxygenation (ECMO)

“…SPFL with hypoxemia and the characteristic resistance to mechanical ventilation have proven particularly difficult to treat. This has led to recent reports of novel approaches to treatment including the use of inhaled nitric oxide and desmopressin (17,18). Although the benefits of corticosteroids in the treatment of ARDS are known, evidence for use of corticosteroids in pulmonary leptospirosis is confined to occasional case reports or small studies (19).…”