Plasma exchange in severe leptospirosis with multi-organ failure: a case report

INTRODUCTION: Leptospirosis presents with disease of variable severity; multi-organ failure can occur. In this situation, plasma exchange has been used with positive results, although the mechanism of action has not been fully explained. CASE PRESENTATION: A 67-year-old Caucasian man developed severe leptospirosis with marked icterus, acute kidney injury and cardiorespiratory failure, after exposure to livestock. On the basis of previous reported cases, he was treated with plasma exchange. This led to a rapid improvement in his bilirubin level, cardiac and respiratory function, followed by renal function. CONCLUSION: We discuss the pathophysiology of the disease, and suggest that plasma exchange has a role in the treatment of severe sepsis caused by leptospirosis as well as immune complex-mediated organ injury.