Veno-venous extracorporeal membrane oxygenation support for severe leptospirosis complicated by pulmonary hemorrhage and refractory acute respiratory distress syndrome: A case report and literature review.

Authors

Xinyi Li, Hui Wen, Fang Wen, Zhao Liu

Published in

Medicine. Volume 105. Issue 32. Pages e50167. Aug 07, 2026.

Abstract

Leptospiral pulmonary hemorrhage syndrome is a rare but life-threatening manifestation of leptospirosis and is frequently complicated by acute respiratory distress syndrome, with persistently high mortality. Using veno-venous extracorporeal membrane oxygenation (VV-ECMO) in this setting remains challenging because systemic anticoagulation may exacerbate pulmonary bleeding.
A 58-year-old male farmer presented with high fever, myalgia, and rapidly progressive dyspnea following possible environmental exposure. He developed severe hypoxemia accompanied by diffuse pulmonary hemorrhage and multi-organ dysfunction.
According to clinical presentations, radiologic findings, and next-generation sequencing of peripheral blood, the diagnosis of severe leptospirosis complicated by pulmonary hemorrhage and refractory acute respiratory distress syndrome was established.
Despite lung-protective mechanical ventilation and adjunctive prone positioning, hypoxemia persisted. VV-ECMO was initiated as rescue therapy using an individualized anticoagulation strategy. Continuous renal replacement therapy with regional citrate anticoagulation was employed to minimize systemic anticoagulant exposure. Pathogen-directed antimicrobial therapy was promptly instituted following microbiological confirmation.
The patient exhibited progressive improvement in oxygenation and organ function. VV-ECMO was successfully weaned after 6 days, followed by extubation and transfer out of the intensive care unit with stable respiratory status.
VV-ECMO may be considered a viable therapy for life-threatening hypoxemia in leptospiral pulmonary hemorrhage when the underlying disease is potentially reversible. Individualized anticoagulation strategies and continued application of lung-protective measures, including prone positioning when feasible, are critical to optimizing outcomes.

PMID:
42566621
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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