DOI: https://doi.org/10.14710/jbtr.v9i2.17625

Plasma Exchange as A Rescue Therapy in Weil’s Disease with Severe Hyperbilirubinemia, Acute Renal Failure, And Multidrug-Resistant Organism Co-Infection: A Rare Case in Critical Care Setting

1Faculty of Medicine, Universitas Diponegoro, Indonesia

2Intensive Care Department, Pantiwilasa Dr. Cipto Hospital, Indonesia

Received: 10 Mar 2023; Revised: 27 Jun 2023; Accepted: 5 Jul 2023; Available online: 31 Aug 2023; Published: 31 Aug 2023.
Open Access Copyright (c) 2023 Journal of Biomedicine and Translational Research
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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Abstract

Background: Leptospirosis is a zoonotic infectious disease caused by spirochete Leptospira interrogans. Weil’s disease is a severe form of leptospirosis. In case of Weil's Disease which did not show improvement despite standard treatment with RRT and antibiotics, an additional therapeutic modality is needed as a rescue therapy in critical condition. Therapeutic plasma exchange (TPE) has been reported to showed positive outcomes in patient with sepsis and leptospirosis. However, TPE has not been widely used in treating severe leptospirosis. We report a case of Weil’s disease with severe hyperbilirubinemia, acute renal failure, and multidrug-resistant organism (MDRO) successfully treated with therapeutic plasma exchange (TPE) and intermittent renal replacement therapy (RRT).

Case Presentation: A 25-year-old male developed Weil’s disease with severe hyperbilirubinemia and acute renal failure. The culture results showed that he was co-infected with multidrug-resistant organism. He failed to improve and fell into a septic shock while treated in the intensive care unit with empirical antibiotics and intermittent RRT. His serum bilirubin rises to 43.34mg/dL. Furthermore, he underwent single TPE and showed rapid clinical improvement with recovery of liver and renal function.

Conclusion: Plasma exchange had a vital role in reducing serum bilirubin and removal of harmful substances. TPE as a rescue therapy can be used for further intensive care support in severe leptospirosis which has not shown improvement despite standard treatment with RRT and antibiotics.

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PLASMA EXCHANGE AS A RESCUE THERAPY IN WEIL’S DISEASE WITH SEVERE HYPERBILIRUBINEMIA, ACUTE RENAL FAILURE, AND MULTIDRUG-RESISTANT ORGANISM CO-INFECTION: A RARE CASE IN CRITICAL CARE SETTING
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Keywords: Leptospirosis; Weil’s disease; plasma exchange; renal replacement therapy; multidrug-resistant organism

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Section: Case Reports
Language : EN
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  8. Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher [Internet]. 2019;34(3):171–354. Available from: https://doi.org/10.1002/jca.21705
  9. Tse KC, Yip PS, Hui KM, Li FK, Yuen KY, Lai KN, et al. Potential benefit of plasma exchange in treatment of severe icteric leptospirosis complicated by acute renal failure. Clin Diagn Lab Immunol [Internet]. 2002;9(2):482–4. Available from: https://doi.org/10.1128/CDLI.9.2.482-484.2002
  10. Taylor D, Karamadoukis L. Plasma exchange in severe leptospirosis with multi-organ failure: A case report. J Med Case Rep [Internet]. 2013;7(1):1. Available from: https://doi.org/10.1186/1752-1947-7-169
  11. TERZİ H, KORKMAZ S, ŞENCAN M, YÖNEM Ö, YILMAZ A, ATASEVEN H. The role of plasma exchange in hyperbilirubinemia from a different perspective. Cumhur Med J [Internet]. 2019;(March):82–7. Available from: https://doi.org/10.7197/223.vi.456725
  12. Hadem J, Hafer C, Schneider AS, Wiesner O, Beutel G, Fuehner T, et al. Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock : retrospective observational single-centre study of 23 patients. 2014; Available from: https://doi.org/10.1186/1471-2253-14-24
  13. Ruiz DD, San FF, Molina FJG De, Úbeda-iglesias A. Plasmapheresis and other extracorporeal filtration techniques in critical patients. 2017;41(3). Available from: https://doi.org/10.1016/j.medin.2016.10.005
  14. Knaup H, Stahl K, Schmidt BMW, Idowu TO, Busch M, Wiesner O, et al. Early therapeutic plasma exchange in septic shock : a prospective open-label nonrandomized pilot study focusing on safety , hemodynamics , vascular barrier function , and biologic markers. 2018;5:1–11. Available from: https://doi.org/10.1186/s13054-018-2220-9
  15. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign : International Guidelines for Management of Sepsis and Septic Shock : 2016 [Internet]. Vol. 43, Intensive Care Medicine. Springer Berlin Heidelberg; 2017. 304–377 p. Available from: https://doi.org/10.1007/s00134-017-4683-6
  16. Buckman SA, Turnbull IR, Mazuski JE. Empiric Antibiotics for Sepsis. Surg Infect (Larchmt) [Internet]. 2018;19(2):147–54. Available from: https://doi.org/10.1089/sur.2017.282
  17. El-Haffaf I, Caissy JA, Marsot A. Piperacillin-Tazobactam in Intensive Care Units: A Review of Population Pharmacokinetic Analyses. Clin Pharmacokinet [Internet]. 2021;60(7):855–75. Available from: https://doi.org/10.1007/s40262-021-01013-1

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