Severe leptospirosis complicated by atypical hemolytic uremic syndrome, myocarditis, and acute liver injury: a therapeutic challenge—a case report and review of the literature

BACKGROUND: Severe leptospirosis, also known as Weil's disease, is a life-threatening zoonotic infection characterized by multi-organ dysfunction, including acute kidney injury and jaundice. We report this case due to its rarity and complex nature. CASE PRESENTATION: This case report describes a 44-year-old previously healthy, Sri Lankan Sinhalese male who presented with high-grade fever, deep jaundice, acute kidney injury, and signs of systemic inflammation. Despite early initiation of intravenous antibiotics, steroids, and supportive care, the patient's condition deteriorated with features suggestive of atypical hemolytic uremic syndrome (aHUS), myocarditis, acute respiratory distress syndrome (ARDS), and acute liver injury. Diagnostic findings revealed severe direct hyperbilirubinemia, intravascular hemolysis, and progressive renal failure requiring sustained low-efficiency dialysis (SLED). Etiology evaluation revealed leptospira Ig M positivity. A multidisciplinary approach, including therapeutic plasma exchange (TPE), was employed, resulting in gradual clinical improvement, although the patient remained dialysis-dependent at discharge. CONCLUSIONS: This case underscores the importance of recognizing atypical complications of leptospirosis and highlights the role of therapeutic plasma exchange as a potential rescue therapy in severe and refractory cases. Further research is needed to optimize management strategies in such complex clinical scenarios.