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

Dominic Taylor* and Lazarus Karamadoukis

Author Affiliations

Renal department, Dorset County Hospital NHS Foundation Trust, Williams Avenue, Dorchester DT1 2JY, UK

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Journal of Medical Case Reports 2013, 7:169  doi:10.1186/1752-1947-7-169

Published: 28 June 2013



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.


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.