title: [Immunomodulation in severe leptospirosis with multiple organ failure: plasma exchange, intravenous immunoglobulin or corticosteroids?].
abstract: We report a case of severe leptospirosis complicated with a multiple organ failure syndrome. A 62-year-old patient presented a picture associating fever, asthenia and myalgias, particularly intense on the calves. The assessment showed acute renal failure, hyperbilirubinemia, severe rhabdomyolysis and thrombocytopenia. Although initial management associating amoxicilline and continuous veino-venous hemodiafiltration, evolution was unfavourable, with SDRA and increase of hyperbilirubinemia. Administration of a bolus of 500 mg of methylprednisolone, associated with intravenous immunoglobulin (0,4 g/kg per day during five days), led to a rapid clinical and biological improvement. Immunomodulation aspects during leptospirosis are discussed.
authors.affiliation: Département d'anesthésie-réanimation, hôpital d'instruction des Armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France. meaudre@club-internet.fr
authors.forename: E
authors.initials: E
authors.lastname: Meaudre
authors.forename: Y
authors.initials: Y
authors.lastname: Asencio
authors.forename: A
authors.initials: A
authors.lastname: Montcriol
authors.forename: C
authors.initials: C
authors.lastname: Martinaud
authors.forename: B
authors.initials: B
authors.lastname: Graffin
authors.forename: B
authors.initials: B
authors.lastname: Palmier
authors.forename: P
authors.initials: P
authors.lastname: Goutorbe
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007922:Leptospirosis / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009102:Multiple Organ Failure / Q000209:etiology*; D010951:Plasma Exchange; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D008775:Methylprednisolone
vernacular_title: Immunomodulation au cours d'un cas de leptospirose grave avec défaillance multiviscérale : échanges plasmatiques, immunoglobulines ou corticoïdes ?