ER 12 Leptospirosis With Septic Emboli Causes Wet Gangrene And Complicates Bilateral Below Knee Amputation In A Young Patient – A Case Report

1Tan HP 1Orthopaedic, Hospital Sungai Buloh, Jalan Hospital 47000 Sungai Buloh, Selangor

Introduction Discussion Leptospirosis is an infection caused by Leptospirosis is a worldwire zoonotic corkscrew-shaped bacteria called Leptospira. infection with a much greater incidence in Common mode of transmission is by animal tropical regions and has now been identified as especially rodents. Severe organ-specific one of the emerging infectious diseases. Most complications are such as acute kidney failure cases of leptospirosis are diagnosed by and pulmonary hemorrhage, which required serology and clinical presentation. Antibodies haemodialysis and ventilator support. are detectable in the blood approximately 5 days after the onset of symptoms. Clinical Case In this case, patient presented in sepsis upon Here, we would like to report this 30-year-old arrival. His general condition deteriorated gentleman, with no past medical illness, who despite multi-displinary involvement with presented with 3 days history of fever, early initiation of appropriate antibiotic. multiple episodes of vomiting and diarrhoea, Urgent decision of major amputation over his associated with multiple purpura lesions over bilateral lower extremities is crucial. Days bilateral lower extremities. after surgery, significant improvement was Furhter history revealed patient never exposed noted. himself to outdoor activity recently such as jungle trekking or waterfall. Apart from Conclusion deranged electrolytes and renal function, he is Several recent outbreaks of Leptospirosis have tested positive for leptospirosis IgM. drawn attention to the potential effects of Without delay, he was intubated in view of climate change and human activity on the worsening respiratory distress with severe incidence of the disease and the broad metabolic acidosis. His lower limbs condition spectrum of clinical manifestation. Early complicated with gangrene with surrounding initiation of antibiotic therapy is important in cellulitis, where it was aggravated by the acute disease. This infection can lead to tissue ischaemia as a results from the multiorgan system complications or even circulatory septic emboli. death in accidental hosts. Scheduled renal replacement therapy commenced due to deteriorating renal function. Unfortunately, his required regular haemodialysis, hence the decision for bilateral below knee amputation to eliminate the source of sepsis with ongoing rhabdomyolysis.

Figure 1 : The above picutre shows bilateral lower limbs wet gangrene up to the level of midfoot secondary to septic emboli.