Zhang Xing-Cheng, Lei Xi-Qun, Sun Yun, Shan Nan-Bing
Department of Critical Care Medicine, Fuyang Infectious Disease Clinical College of Anhui Medical University, Fuyang, Anhui Province, China.
Department of Critical Care Medicine, the Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province, China.
Medicine (Baltimore). 2024 Dec 20;103(51):e40942. doi: 10.1097/MD.0000000000040942.
The mortality rate associated with pulmonary hemorrhage induced by leptospirosis is notably high. Available treatment modalities are limited, and their efficacy has not been fully demonstrated. Here, we present the case report of a patient with leptospirosis-induced pulmonary hemorrhagic syndrome. A 49-year-old male patient was admitted to the Surgical Ward of the Department of Intensive Care Medicine of Fuyang Infectious Disease Clinical College of Anhui Medical University. The patient had initially sought medical attention at a local hospital due to symptoms of fever persisting for 4 days and chest tightness accompanied by hemoptysis for 1 day.
We present the case report of a patient with leptospirosis-induced pulmonary hemorrhagic syndrome. Hemoptysis persisted in our patient during VV-ECMO, although we adjusted the heparin regimen to maintain an activated partial thromboplastin time target value of 50 to 55 seconds.
Leptospirosis-induced pulmonary hemorrhagic syndrome.
He was immediately intubated and mechanically ventilated and then transferred to our hospital for further medical intervention. Upon arrival at our hospital, he was treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO). Consequently, he was administered penicillin and omacycline for anti-infective therapy. Anti-inflammatory agents, high-dose vasoactive drugs to enhance blood pressure, continuous renal replacement therapy, tracheal sputum aspiration, and ventilator-assisted ventilation were also administered as part of the treatment protocol.
After treatment, his inflammation index was significantly decreased, the amount of pulmonary bleeding was reduced, his oxygenation ratio was improved, and the pulmonary lesions were absorbed. Consequently, he was discharged on the 34th day of hospitalization.
We successfully treated a case of leptospirosis pulmonary hemorrhagic syndrome using VV-ECMO combined with prudent anticoagulant therapy.
钩端螺旋体病所致肺出血的死亡率显著较高。现有的治疗方式有限，且其疗效尚未得到充分证实。在此，我们报告一例钩端螺旋体病所致肺出血综合征患者的病例。一名49岁男性患者入住安徽医科大学阜阳传染病临床学院重症医学科外科病房。该患者最初因持续发热4天及胸闷伴咯血1天在当地医院就诊。
我们报告一例钩端螺旋体病所致肺出血综合征患者的病例。尽管我们调整了肝素方案以维持活化部分凝血活酶时间目标值在50至55秒，但患者在静脉-静脉体外膜肺氧合（VV-ECMO）治疗期间仍持续咯血。
钩端螺旋体病所致肺出血综合征。
他立即接受气管插管和机械通气，随后转至我院接受进一步治疗。到达我院后，对其进行了静脉-静脉体外膜肺氧合（VV-ECMO）治疗。因此，给予青霉素和奥美环素进行抗感染治疗。作为治疗方案的一部分，还给予了抗炎药物、大剂量血管活性药物以提高血压、持续肾脏替代治疗、气管吸痰及呼吸机辅助通气。
治疗后，其炎症指标显著下降，肺出血量减少，氧合比改善，肺部病变吸收。因此，他在住院第34天出院。
我们成功地使用VV-ECMO联合谨慎的抗凝治疗方案治疗了一例钩端螺旋体病肺出血综合征病例。
