Management of Severe Leptospirosis in the Intensive Care Unit: A Case Report and Review of Diagnostic and Therapeutic Challenges.

Severe leptospirosis is a zoonotic disease with a global distribution, which can be severe, requiring intensive care management due to its potential for multi-organ dysfunction. This case report describes a 57-year-old male patient with a history of alcohol abuse, dyslipidemia, and hypertension, who presented with severe leptospirosis. The patient exhibited symptoms including generalized myalgia, abdominal pain, vomiting, and jaundice. Initial laboratory results revealed significant abnormalities, such as elevated liver enzymes, high bilirubin levels, and severe thrombocytopenia. Despite broad-spectrum antimicrobial therapy, the patient developed acute respiratory distress syndrome and required admission to the intensive care unit. Organ support interventions included mechanical ventilation with protective strategies, prone positioning, and continuous renal replacement therapy. The patient's condition was further complicated by an anuric state, delaying confirmation of leptospirosis through polymerase chain reaction (PCR) testing. Empiric treatment with ceftriaxone and corticosteroids was initiated, leading to gradual clinical improvement. The patient was extubated after 13 days but developed severe critical illness-related myopathy, which led to prolonged hospital admission, but eventually made a full recovery. This case highlights the importance of timely diagnosis and intervention in severe leptospirosis, emphasizing the role of intensive care management in improving patient outcomes. Further research is needed to establish standardized treatment protocols for severe leptospirosis, particularly concerning antimicrobials and corticosteroids.