Leptospirosis Associated Digital Gangrene of Lower Extremities: Two Cases and Review of Literature


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Abstract

Background:Leptospirosis is the most common zoonotic illness worldwide, caused by pathogenic spirochete bacteria called Leptospira. It is clinically presented with mild to moderate in most cases. However, sometimes, the course may be severe with multiorgan dysfunction.

Case Presentation:We present two rare cases of leptospirosis with peripheral dry gangrene of the lower extremities. A 25-year-old male, farmer by occupation without any significant past medical history had been diagnosed with a case of leptospirosis that complicated to digital gangrene on 15 days of illness during hospitalization. Another 21-year-old male student was admitted for leptospirosis and developed digital gangrene on 19 days of illness. All clinical findings were resolved on the steroid.

Conclusion:Apart from a high index of suspicion and awareness of unusual manifestations, serology plays a vital role in making an accurate and quick diagnosis to initiate appropriate therapy.

About the authors

Anju Dinkar

Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences

Email: info@benthamscience.net

Jitendra Singh

Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University

Author for correspondence.
Email: info@benthamscience.net

Mahima Yadav

Department of Pathology, Institute of Medical Sciences, Banaras Hindu University

Email: info@benthamscience.net

References

  1. National Guidelines on Management of Leptospirosis. http://www.epid.gov.lk/web/images/pdf/Publication/leptospirosis/lepto_national_guidelines.pdfAccessed May 11, 2023.
  2. Maier A, Kaeser R, Thimme R, Boettler T. Acute pancreatitis and vasoplegic shock associated with leptospirosis – a case report and review of the literature. BMC Infect Dis 2019; 19(1): 395. doi: 10.1186/s12879-019-4040-1 PMID: 31068145
  3. Winslow WE, Merry DJ, Pirc ML, Devine PL. Evaluation of a commercial enzyme-linked immunosorbent assay for detection of immunoglobulin M antibody in diagnosis of human leptospiral infection. J Clin Microbiol 1997; 35(8): 1938-42. doi: 10.1128/jcm.35.8.1938-1942.1997 PMID: 9230359
  4. Case management prevention and control of leptospirosis. Available from: https://ncdc.gov.in/WriteReadData/l892s/File558.pdf Accessed May 11, 2022.
  5. Panagopoulos P, Terzi I, Karanikas M, Galanopoulos N, Maltezos E. Myocarditis, pancreatitis, polyarthritis, mononeuritis multiplex and vasculitis with symmetrical peripheral gangrene of the lower extremities as a rare presentation of leptospirosis: a case report and review of the literature. J Med Case Reports 2014; 8(1): 150. doi: 10.1186/1752-1947-8-150 PMID: 24885926
  6. Pfaller M, Wray RC Jr. Leptospirosis and limb gangrene. Case report. Mo Med 1979; 76(3): 157-9. PMID: 423880
  7. Batra P, Gopi S, Vinayraj EV, et al. A rare case of complicated pancreatitis due to leptospirosis. Indian J Med Microbiol 2022; 40(4): 602-4. doi: 10.1016/j.ijmmb.2022.07.006 PMID: 35927141
  8. Yücel Koçak S, Kudu A, Kayalar A, Yilmaz M, Apaydin S. Leptospirosis with acute renal failure and vasculitis: A case report. Arch Rheumatol 2018; 34(2): 229-32. PMID: 31497771
  9. Zamri Z, Shaker AH, Razman J. Leptospirosis complicating with acute large bowel gangrene: A case report. Clin Ter 2012; 163(5): 399-400. PMID: 23099969
  10. Wong ML, Kaplan S, Dunkle LM, Stechenberg BW, Feigin RD. Leptospirosis: A childhood disease. J Pediatr 1977; 90(4): 532-7. doi: 10.1016/S0022-3476(77)80361-2 PMID: 557083
  11. Krishna PV, Ahmed S, Ravi Kumar CV. A case of leptospirosis with rare atypical presentation as paraparesis. J Clin Sci Res 2015; 4(2): 173-6. doi: 10.15380/2277-5706.JCSR.13.061
  12. Rajapakse S, Rodrigo C, Balaji K, Fernando SD. Atypical manifestations of leptospirosis. Trans R Soc Trop Med Hyg 2015; 109(5): 294-302. doi: 10.1093/trstmh/trv026 PMID: 25813883
  13. Bell MJ, Ternberg JL, Feigin RD. Surgical complications of leptospirosis in children. J Pediatr Surg 1978; 13(3): 325-30. doi: 10.1016/S0022-3468(78)80408-4 PMID: 671199
  14. Bee PC, Chow SK, Tan LH. A case of severe leptospirosis with pancytopaenia. Med J Malaysia 2003; 58(5): 777-9. PMID: 15190670
  15. Solmazgul E, Turhan V, Unver S, Demirci M, Nalbant S, Danaci M. A case of Weil’s syndrome developing steroid resistant immune haemolytic anaemia. Scand J Infect Dis 2005; 37(9): 700-2. doi: 10.1080/00365540510040214 PMID: 16126576
  16. Panicker JN, Mammachan R, Jayakumar RV. Primary neuroleptospirosis. Postgrad Med J 2001; 77(911): 589-90. doi: 10.1136/pmj.77.911.589 PMID: 11524519
  17. Chandra SR, Kalpana D, Anilkumar TV, Kabeer KA, Chithra P, Bhaskaran R. Acute disseminated encephalomyelitis following leptospirosis. J Assoc Physicians India 2004; 52: 327-9. PMID: 15636341
  18. Lin C, Wu MS, Yang CW, Huang CC. Leptospirosis associated with hypokalaemia and thick ascending limb dysfunction. Nephrol Dial Transplant 1999; 14(1): 193-5. doi: 10.1093/ndt/14.1.193 PMID: 10052507
  19. Krishnan A, Karnad DR, Medhekar TP. Paralysis due to renal potassium wasting: An unusual presentation of leptospirosis. Nephrol Dial Transplant 2003; 18(11): 2454-5. doi: 10.1093/ndt/gfg350 PMID: 14551392
  20. Fernando T, Rodrigo C, Samarakoon L, et al. Electrocardiographic and echocardiographic manifestations of cardiac involvement in leptospirosis. Trans R Soc Trop Med Hyg 2013; 107(7): 457-9. doi: 10.1093/trstmh/trt038 PMID: 23732365
  21. Assimakopoulos SF, Michalopoulou S, Papakonstantinou C, Lekkou A, Syrokosta I, Gogos C. A case of severe sinus bradycardia complicating anicteric leptospirosis. Am J Med Sci 2007; 333(6): 381-3. doi: 10.1097/MAJ.0b013e3180659578 PMID: 17570992
  22. Alexander A, Baer A, Fair JR, Gochenour WS Jr, King JH Jr, Yager RH. Leptospiral uveitis; report of a bacteriologically verified case. AMA Arch Opthalmol 1952; 48(3): 292-7. doi: 10.1001/archopht.1952.00920010300003 PMID: 14952090
  23. Rowen GE. Leptospiral Uveitis. Arch Ophthalmol 1957; 58(5): 754-7. doi: 10.1001/archopht.1957.00940010776017 PMID: 13468860
  24. Koe L, Tan KT, Tan TC. Leptospirosis in pregnancy with pathological fetal cardiotocography changes. Singapore Med J 2014; 55(2): e20-4. doi: 10.11622/smedj.2013194 PMID: 24712035
  25. Gaspari R, Annetta MG, Cavaliere F, et al. Unusual presentation of leptospirosis in the late stage of pregnancy. Minerva Anestesiol 2007; 73(7-8): 429-32. PMID: 17637589
  26. O Olubaniyi A, Short CE, Remedios D, Kapembwa M. An unexpected cause of digital gangrene: HIV associated peripheral arterial thrombosis. Br J Gen Pract 2013; 63(608): 162-3. doi: 10.3399/bjgp13X664441 PMID: 23561781
  27. Singh J, Himanshu D, Nim RK, Dinkar A, Gupta KK. Meningitis with digital gangrene in meningococcal infection: An atypical presentation. J Clin Diagn Res 2016; 10(12): OD03-4. doi: 10.7860/JCDR/2016/22206.9017 PMID: 28208911
  28. Prasannan A, Ramaswamy P, Anirudhan VK. Rickettsial fever presenting with gangrene: A case series. J Clin Diagn Res 2017; 11(6): PR01-3. doi: 10.7860/JCDR/2017/25371.10024 PMID: 28764251
  29. Joshi HS, Thomas M, Warrier A, Kumar S. Gangrene in cases of spotted fever: A report of three cases. BMJ Case Rep 2012; 2012(dec18 1): bcr2012007295. doi: 10.1136/bcr-2012-007295 PMID: 23257640

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