Pancreatitis as a severe complication of leptospirosis with fatal outcome: a case report

Gomes, Pedro Eduardo Andrade de Carvalho; Brilhante, Sávio de Oliveira; Carvalho, R.; Sousa, Daniel Ribeiro de; Daher, Elizabeth De Francesco

doi:10.1590/s1678-9946201961063

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…The sensitivity and specificity of an elevated amylase concentration are high on the first day of the CP of AP but decrease thereafter. 54 Smith et al 55 reported a 76.8% sensitivity and 92.6% specificity for amylase in patients with AP. In the present review, hyperamylasemia was seen in 70.8% of patients with AP secondary to leptospirosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of patients with leptospirosis complicated with acute pancreatitis: a systematic review

Charles,

Jayarajah,

Subasinghe

2023

J Int Med Res

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Objectives Acute pancreatitis (AP) is a severe complication of leptospirosis. This review focuses on the current evidence of AP in patients with leptospirosis. Methods Data on clinical characteristics, biochemical parameters, diagnosis, complications, critical care, fluid management, operative management, and outcomes were analyzed. This study was registered in PROSPERO (CRD42022360802). Results We included 35 individual case reports and 4 case series involving 79 patients. Sex was reported for 48 (60.7%) patients; 38 (48.1%) were male and 10 (12.6%) were female. The patients’ mean age was 45.13 (15–83 years). Acute kidney injury, thrombocytopenia, hypotension, and liver injury were the most common complications reported. Complete recovery was reported for 36 (45.5%) patients. Biochemical and radiological recovery was reported for 10 (12.6%) and 9 (11.3%) patients, respectively. Death was reported in 18 (22.7%) patients. Conclusion A high degree of clinical suspicion and different modalities of investigations are essential in the diagnosis of AP in leptospirosis. AP can be easily missed in leptospirosis because both conditions share similar clinical presentations and complications. Because of the high prevalence of acute kidney injury, judicious fluid management and close monitoring are mandatory.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of patients with leptospirosis complicated with acute pancreatitis: a systematic review

Charles,

Jayarajah,

Subasinghe

2023

J Int Med Res

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“…Activation of Toll-like 2 receptors, dysregulation in immunomodulation, small vessel vasculitis and ischaemia are some of the proposed mechanisms of pancreatic involvement in leptospirosis. 16 17 A two-centre observational study by Goswami et al reported a 5% incidence of AP among patients with leptospirosis. 18 In contrast, Herath et al reported a higher incidence at 66.67% in their case series.…”

Section: Discussionmentioning

confidence: 99%

“…AP in the setting of leptospirosis is infrequently reported, and its mechanism is poorly understood. Activation of Toll-like 2 receptors, dysregulation in immunomodulation, small vessel vasculitis and ischaemia are some of the proposed mechanisms of pancreatic involvement in leptospirosis 16 17. A two-centre observational study by Goswami et al reported a 5% incidence of AP among patients with leptospirosis 18.…”

Section: Discussionmentioning

confidence: 99%

Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study

Madrigal

Panlilio

Burog

et al. 2023

BMJ Open Gastroenterol

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BackgroundAcute pancreatitis (AP) is an infrequently reported manifestation of leptospirosis. It is more commonly seen in patients with acute respiratory distress syndrome. Despite novel modalities such as extracorporeal membrane oxygenation (ECMO), the mortality rate remains high and whether this is associated with the lung injury caused by the inflammation in AP remains unclear.Objectives and methodsA descriptive study was conducted at a tertiary hospital in the Philippines. Primary outcome was defined as the presence or absence of AP. Secondary outcomes were defined as 28-day mortality rate, length of hospital stay, ECMO days, renal replacement therapy (RRT) days, days on mechanical ventilation, presence of local complications of AP and development of nosocomial infections.ResultsA total of 27 patients were included in the study, and 88.89% (n=24) were men. The mean age for all patients was 33.59±10.22 years. Out of the 27 patients, 19 (70.37%) were diagnosed with AP. Among these 19 patients, one (5.26%) had necrotising pancreatitis and two (10.52%) developed local complications of pancreatitis. Six patients (31.58%) died among those who developed AP, while one (12.50%) died among those who did not. The duration of hospital stay, ECMO, RRT, mechanical ventilation and development of nosocomial infections was also higher in the group who presented with AP.ConclusionAP is an under-reported complication of leptospirosis. Our study demonstrated a higher mortality and morbidity in patients with leptospirosis who developed AP.

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“…The mechanism of acute pancreatitis in leptospirosis is incompletely understood. It has been proposed that activation of toll-like receptor 2 may trigger an inflammatory pathway leading to vasculitis and endothelial damage to the pancreas [ 8 ]. A literature review conducted by Maier et al (2019) found that only 17 cases of leptospirosis-associated pancreatitis have been published in the literature from 2002-2019 and that they were mainly localized to Central Europe and Sri Lanka [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Icteric Leptospirosis Leading to Multiorgan Failure and Concomitant Pancreatitis

Canakis¹,

Bechara²,

Turki³

et al. 2023

Cureus

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Leptospirosis is a zoonotic disease caused by the spirochete Leptospira interrogans with a majority of cases occurring in the tropics. Diagnosing leptospirosis is challenging due to the variable and non-specific clinical presentation. While severe leptospirosis may present with renal failure, liver failure, and pulmonary hemorrhage, there are few described cases of renal failure and liver failure accompanied by pancreatitis and dysrhythmias, particularly in temperate climates. We present a case of severe leptospirosis presenting with bilateral calf pain, acute oliguric renal failure, acute liver failure, dysrhythmias, and pancreatitis. Clinicians must consider this diagnosis in temperate climates and consider testing and empirically treating for leptospirosis in patients with similar symptom constellations, vague symptoms, and lab abnormalities of unknown etiology.

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Pancreatitis as a severe complication of leptospirosis with fatal outcome: a case report

Cited by 7 publications

References 19 publications

Clinical characteristics and outcomes of patients with leptospirosis complicated with acute pancreatitis: a systematic review

Clinical characteristics and outcomes of patients with leptospirosis complicated with acute pancreatitis: a systematic review

Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study

Icteric Leptospirosis Leading to Multiorgan Failure and Concomitant Pancreatitis

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