title: Pediatric Fulminant Leptospirosis Complicated by Pericardial Tamponade, Macrophage Activation Syndrome and Sclerosing Cholangitis.
abstract: BACKGROUND
  Leptospirosis is a zoonotic infectious disease caused by pathogenic spirochetes of the genus Leptospira. Although it is usually asymptomatic and self-limited, severe potentially fatal illness accompanied by multi-organ failure may occur.
  
  
  METHODS
  Here we report an unusual case of severe leptospirosis successfully treated with continuous venovenous hemofiltration (CVVHF) and therapeutic plasma exchange (TPE). The patient presented with pericardial tamponade, renal failure and macrophage activation syndrome, and later suffered prolonged jaundice and sclerosing cholangitis during hospitalization in the pediatric intensive care unit (PICU). To the best of our knowledge, sclerosing cholangitis due to leptospirosis has not been reported in the literature.
  
  
  CONCLUSIONS
  Leptospirosis should be kept in mind in the differential diagnosis of sepsis and septic shock with fever, thrombocytopenia, jaundice and renal failure. TPE and CVVHF should start early after the diagnosis of leptospirosis with multiorgan failure.
authors.affiliation: Pediatric Intensive Care Unit, Pediatric Critical Care Medicine, Bakırköy Dr. Sadi Konuk Research and Training Hospital, İstanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Yeşilbaş
authors.affiliation: Pediatric Intensive Care Unit, Pediatric Critical Care Medicine, Bakırköy Dr. Sadi Konuk Research and Training Hospital, İstanbul, Turkey.
authors.forename: Hasan Serdar
authors.initials: HS
authors.lastname: Kıhtır
authors.affiliation: Pediatric Intensive Care Unit, Pediatric Critical Care Medicine, Bakırköy Dr. Sadi Konuk Research and Training Hospital, İstanbul, Turkey.
authors.forename: Hamdi Murat
authors.initials: HM
authors.lastname: Yıldırım
authors.affiliation: Division of Pediatric Infectious Disease, Department of Pediatrics, Bakırköy Dr. Sadi Konuk Research and Training Hospital, İstanbul, Turkey.
authors.forename: Nevin
authors.initials: N
authors.lastname: Hatipoğlu
authors.affiliation: Pediatric Intensive Care Unit, Pediatric Critical Care Medicine, Bakırköy Dr. Sadi Konuk Research and Training Hospital, İstanbul, Turkey.
authors.forename: Esra
authors.initials: E
authors.lastname: Şevketoğlu
keywords: Leptospirosis; macrophage activation syndrome; pericardial tamponade; sclerosing cholangitis