Severe course of leptospirosis (clinical case)

Abstract

The article describes a clinical case of severe leptospirosis. Patient K., was admitted to the neurosurgical department on 26.11.2023 with a diagnosis of «Closed craniocerebral injury dated 22.11.2023. Severe brain injury. Linear fracture of the occipital bone. Eyelid hematoma. An abrasion of the upper eyelid on the right». On 29.11.2023, an objective examination drew attention to an increase in body temperature to 39.50 C, subictericity of the sclera and skin, conjunctival injections. There is a hemorrhagic rash on the skin of the trunk and limbs. Hemodynamics is unstable, episodes of arterial hypotension. Laboratory examination revealed mild anemia, signs of hepatic-renal insufficiency, hyperbilirubinemia, increased concentrations of creatine phosphokinase, C-reactive protein, procalcitonin. Hepatic-renal insufficiency increased in dynamics, the level of creatine phosphokinase and procalcitonin increased. Additionally, the differential diagnostic search was aimed at identifying infectious diseases: hemorrhagic fever with renal syndrome, leptospirosis, malaria, viral hepatitis. Immunoglobulins of class M to Leptospira interrogans were detected (11.12.2023). The patient received antibacterial therapy, extracorporeal detoxification operations, artificial ventilation, infusion therapy, correction of the hemostasis system were performed in parallel. Against the background of complex treatment, the patient's condition was stabilized, and the patient was discharged from the hospital on 61 days with restoration of health.