A death of a pregnant mother following Leptospirosis

Introduction

Although leptospirosis is known to occur in Sri Lanka, its incidence has increased during the recent past. Because of the protean manifestations of leptospirosis it is sometimes misdiagnosed and underreported.

Case report

A 30 year old pregnant mother (POA 32 weeks) was transferred from a peripheral hospital with signs of icterus and vomiting for 3 days. She was treated by the Obstetrician as having HELLP syndrome. Hematological studies showed elevated liver enzymes and altered clotting profile. After an emergency caesarian section, she developed profuse haemorrhage and a subtotal hysterectomy was done. Although bleeding was arrested, her condition gradually deteriorated. She died in the ICU one week later.

Autopsy findings:

Yellow discolouration of conjunctiva and nail beds, and marked yellow stained pleural effusion and ascites were seen. Lungs were congested and heavy. Heart appeared flabby and yellow in colour. Kidneys were soft and enlarged with congested cortex. Cortico-medullary junction was well demarcated.

Liver was enlarged and yellow. Histopathology revealed extensive pulmonary haemorrhages and focal hepatic necrosis. The serology report was positive for Leptospira (titer – 1600)

Conclusions

This death warrants the need of constant use of our knowledge in General Medicine, together with our specific knowledge which is confined to a particular specialty. The serology report confirmed the autopsy diagnosis. Therefore, the need to carry out all the relevant specific investigations is highlighted here.

Medico-Legal Journal of Sri Lanka 2013; 1(3) : 20-22