activation has been proposed. Splenic sequestration and aplastic crisis might be involved as well.
declined rapidly afterward, while his reticulocyte count spiked from 11% to 27%, and ferritin levels rose to 33,000. Subsequent transfusions resulted in an increasingly poor response. Hematology recommended holding transfusions, starting IVIG 1g/kg for 5 days, and continuing steroids at the same dose. On day 3, his hemoglobin began to gradually increase after it reached an extreme low of 4.8 mg/dl. The patient was discharged after his hemoglobin reached 7.3 mg/dl. Discussion: Managing patients with recurrent hyperhaemolysis syndrome can be extremely stressful due to limited treatment data. Blood transfusions are not an option as they may precipitate further hemolysis. Currently, only 5 known cases have been reported. The patient’s significant response to IVIG along with methylprednisolone offers a valuable treatment option to guide physicians’ decisions in the future. Initiating treatment with the biologic Tocilizumab is also an option that has shown benefit in similar cases.
Case: A 27-year-old male with sickle cell disease, hemochromatosis secondary to blood transfusions, a previous episode of hyperhaemolysis syndrome, unprovoked pulmonary embolism, and aortic stenosis presented with pain in his lower back and right lower leg unrelieved with home pain medications, similar to his pain crisis, with hydrocodone providing temporary relief. Over the last year, he had 8 emergency department visits and 5 admissions for pain management and blood transfusions. On physical exam, the patient was hypotensive 99/67 mmHg and tenderness in his right shin and lumbar spine, with unremarkable imaging. He also had a grade 3/5 systolic murmur in the right upper sternal border, which had been consistent with his aortic stenosis. The patient’s hemoglobin dropped from 8 to 5.6 mg/dL, prompting a transfusion of two units of packed red blood cells with methylprednisolone administered beforehand. However, his hemoglobin
LEPTOSPIROSIS: AN UNCOMMON CAUSE OF FEVER AND TRANSAMINITIS IN THE CONTINENTAL UNITED STATES
Allen Byl, Hope Oddo Moise, Danielle Gilbert, Michael Olejniczak, Ashley Misky, Tom Fox, Alexa Lapointe, Michael Modica, Michelle Blyth; Louisiana State University, New Orleans, LA.
Introduction: Leptospirosis is a zoonotic and waterborne infection caused by the spirochete genus Leptospira. Its primary reservoir hosts are small rodents, which can transmit the infection to cattle, swine, dogs, and humans. Infected animals shed Leptospira in urine, allowing the bacteria to spread through contaminated soil or water via breaks in the skin or mucous membranes. Case: A 24-year-old man presented with fevers, rigors, body aches, and headache for 6 days after returning from a 2-week trip to Colombia. During the trip, he went white-water rafting, drank filtered stream water, and had prolonged insect exposure. No other travelers reported similar illness. He was febrile to 101.2°F but lacked rash, lymphadenopathy, or conjunctival injection. Initial workup showed thrombocytopenia (110 x 10³/µL), elevated haptoglobin (239 mg/dL), transaminitis (ALT 196 U/L, AST 131 U/L), and total bilirubin 1.8 mg/dL. Testing for acute hepatitis was negative,
and imaging was unremarkable. Infectious diseases (ID) were concerned for Leptospirosis, Hantavirus, mononucleosis, and arthropod-transmitted diseases including malaria, Dengue fever, Chikungunya virus, and Zika virus, for which send-out labs were ordered. The patient reported improved symptoms and requested to be discharged on day two of admission. His labs were trending downward. Following ID recommendations, he was discharged with seven days of empiric doxycycline while awaiting results. Several weeks later, his Leptospira IgM returned positive, and he subsequently experienced full symptom resolution. Discussion: Leptospira infection can present with mild symptoms but may lead to severe outcomes in up to 10% of cases, characterized by rapid onset of fever, headache, muscle aches, and gastrointestinal involvement. While conjunctival suffusion is common, it may not always be present. Severe infections can affect multiple organ systems, leading to multisystem 39
Made with FlippingBook Digital Publishing Software