Autoimmune Hemolytic Anemia Associated With Leptospirosis: A Rare Complication.

Abstract

Introduction: Autoimmune hemolytic anemia (AIHA) is rare but potentially life-threatening complication of leptospirosis, a zoonotic infection caused by the Leptospira species. Autoimmune hemolytic anemia occurs when the immune system targets red blood cells, resulting in hemolysis and anemia. The relationship between leptospirosis and AIHA is uncommon and often under-recognized, which can delay diagnosis and management. This case highlights the importance of considering hematologic complications in leptospirosis.

Case presentation: A 23-year-old male presented with low-grade fever, productive cough, shortness of breath, jaundice, and pallor for 15 days. On examination, he was pale and icteric with bilateral chest crepitations. Laboratory studies showed severe anemia (hemoglobin 5.5 g/dL), elevated lactate dehydrogenase (1027 U/L), hyperbilirubinemia, thrombocytopenia, and peripheral smear evidence of hemolysis. A direct Coombs' test was strongly positive. Leptospira immunoglobulin M serology confirmed the diagnosis. The patient was managed with broad-spectrum antibiotics (piperacillin-tazobactam and doxycycline) and high-dose corticosteroids (1 mg/kg/day). He improved clinically with stabilization of hemoglobin and a resolution of symptoms.

Conclusion: This case demonstrates a rare immune-mediated manifestation of leptospirosis presenting as AIHA without hepatic or renal failure. Clinicians should maintain a high index of suspicion for hematologic complications in leptospirosis. Early recognition and timely initiation of corticosteroid therapy alongside antibiotics can improve patient outcomes.