A 16-year-old male resident in Chimbar, VI Region.
She had a history of epilepsy under treatment with fenobarbital.
The patient was admitted to the ICU of Luco Trudeau Hospital on the fourth day of evolution with a history of cough, hemoptoic expectoration, respiratory apremium and anterior epistaxis.
The anamnesis described in the first days a clinical picture characterized by fever, malaise, myalgia, headache, vomiting and consciousness compromise.
On the second day of the disease intense abdominal pain, choluria and pain had been added.
the patient was initially admitted to the Emergency Unit of the Hospital de Chimbar, oriented to dopamine, and referred with the diagnosis of acute hepatitis to the Hospital de San Fernando, in a state of hypotension, tachycardia, epistaxis and abdominal pain
Physical examination revealed intense jaundice of the skin and sclera, tachycardia, tachypnea, normotension and fever (38°C axillary), decreased pulmonary murmur in the left lower hemifield and present in the left lower hemifield
Approximately 50 minutes later, she was in a state of septic shock and had to be intubated, a maneuver during which rutile blood was removed through the airway and described as having been taken to the ICU.
From then on she presented with orotracheal discomfort and scarce spontaneous breathing she had to be assisted, bleeding through the tube, jaundice and reactive isochory.
The patient was connected to mechanical ventilation due to a desaturation of 65%, while he was tachycardic but with normotis.
She was admitted with the following diagnoses: septic shock, adult respiratory distress syndrome and the hypothesis of leptospirosis.
He was admitted to the ICU despite advanced resuscitation maneuvers.
Pathological anatomy
Morphological findings are related to alterations in microstructure, characterized by venulocapilar panvasculitis in all organs and systems.
In the lungs, extensive areas of parenchymal hemorrhage and alveolar necrosis microscopy were observed.
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Extensive areas of hepatocellular necrosis and portal lymphoplasmacytic inflammatory infiltrate were observed in the liver parenchyma.
Myocardial degeneration was focal lymphocytic and extensive interstitial infiltrate.
The renal parenchyma showed vascular congestion, lymphoplasmacytic vasculitis and extensive acute tubular necrosis.
With Warthin-Starry's argentic staining, tubular epithelium-like formations, characteristic of leptospira, were identified.
Morphometric methods established an average length of 13 mμ.
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Anatomopathological diagnoses:
• Weil’ s disease (leptospirosis) with:
- Parenchymal pulmonary haemorrhage - necrotizing alveolitis. - Vernulo-capilar panvasculitis - Acute tubular necrosis - acute lymphocytic interstitial nephritis - lymphocytic pericarditis
