Abstract: TH-PO117
In the Aftermath of Hurricane Maria, a New Threat Arises
Session Information
- AKI: Biomarkers, Drugs, Onco-Nephrology
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Andujar, Krystahl Z., University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Ocasio Melendez, Ileana E., University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Cintron-Rosa, Fatima B., University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Vargas Otero, Pedro, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Rivera-Bermudez, Carlos G., University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Quintana-Serrano, Melanie, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
Introduction
The 2017 Atlantic Hurricane Season was among the most active in history and on September 20th, Hurricane Maria struck the island of Puerto Rico. Human leptospirosis is endemic in Puerto Rico and reaches epidemic levels after natural disasters.
Case Description
A 51-year-old farmer presented after a 5-day history of cough with bloody sputum, yellow skin, fever, nausea, vomiting and myalgias. Symptoms began after consuming a banana found on the ground weeks after Hurricane Maria. Vital signs were unremarkable. Physical examination revealed lung rales, conjunctival suffusion and jaundice. Laboratories showed leukocytosis, anemia and thrombocytopenia; creatinine 6.27, BUN 123 and bilirubin 27.4 mg/dL; ALT 44 and AST 114 U/L. ABGs revealed hypoxemia. Chest CT scan without IV contrast was positive for diffuse bilateral ground glass opacities and interlobular septal thickening, worrisome for alveolar hemorrhage. Ultrasound revealed normal liver and bile ducts, and normal kidneys without obstruction. Leptospirosis was considered as a cause of illness and he was started on Ceftriaxone. Within the first 8 hours of admission, his respiratory function deteriorated requiring mechanical ventilation. Daily high-dose hemodialysis was prescribed. Serology was positive for Leptospirosis. Due to respiratory deterioration and rise in bilirubin levels, the decision was made to begin plasma exchange. Over the next 48 hours of admission, he underwent two 4-liter exchanges using fresh frozen plasma. After two plasma exchange sessions, there was a reduction of serum bilirubin to 7.6. Respiratory function improved and patient was extubated. He had recovery of renal function and hemodialysis was discontinued.
Discussion
Puerto Rico has reported at least 76 cases of suspected and confirmed leptospirosis in the aftermath of Hurricane Maria. Our patient presented the most severe form of leptospirosis, Weil’s disease, that comprises jaundice, renal and respiratory failure and a high mortality rate. There are few case reports documenting the benefits of plasma exchange with severe leptospirosis. Given the dramatic recovery of our patient after plasma exchange, we conclude that more research is needed to define its role in patients with severe leptospirosis without clinical improvement after standard therapy.