Share |

Leptospirosis with Pulseless Electrical Activity (PEA) Cardiac Arrest in Multiple Comorbid Patient

Case report

Abstrak

Leptospirosis adalah salah satu penyakit yang endemik di Malaysia. Ia mempunyai pelbagai manifestasi klinikal bermula daripada yang ringan sehingga yang boleh membawa maut. Kami melaporkan sebuah kes tentang seorang lelaki berumur 56 tahun dengan pelbagai masalah kesihatan terdahulu, dengan sejarah tidak sihat kerana demam, batuk dan sakit perut selama dua hari. Pesakit datang ke Jabatan Kecemasan dalam keadaan tidak sedarkan diri dengan Pulseless Electrical Activity (PEA) cardiac arrest. Pesakit telah diresusitasi dan berjaya dipulihkan dengan mencapai peredaran darah spontan (return of spontaneous circulation) tidak berapa lama selepas itu. Keadaan pesakit dirumitkan lagi dengan keadaan Hyperosmolar Hyperglycemic State (HHS), oliguric acute kidney injury, dan  non-ST elevation myocardial infarction (NSTEMI). Pesakit kemudian dimasukkan ke unit rawatan rapi dan dirawat dengan IV Ceftriaxone 2 g sekali sehari selama empat hari, dan kemudian ditukar kepada IV Ceftazidime 2 g dua kali sehari untuk seminggu disebabkan ventilator acquired pneumonia (VAP). Keadaan pesakit bertambah baik dan akhirnya di benarkan pulang ke rumah pada hari yang ke 18.   

Abstract

Leptospirosis is one of the endemic diseases in Malaysia. It has a broad spectrum of clinical manifestation ranging from mild illness to life-threatening illness. We report a case of 56-year-old male with multiple comorbidities, who came with history of fever, cough, abdominal pain, vomiting and diarrhea for two days. He presented to the Emergency Department (ED) unresponsive with pulseless electrical activity (PEA). He was resuscitated and achieved return of spontaneous circulation (ROSC) shortly after it. It was complicated with hyperosmolar hyperglycemic state (HHS), oliguric acute kidney injury and non-ST elevation myocardial infarction (NSTEMI). He was then admitted to intensive care unit (ICU) and treated with IV Ceftriaxone 2 g daily for 4 days then was changed to IV Ceftazidime 2 g twice per day for 1 week because of ventilator acquired pneumonia (VAP). His condition improved and was discharge home well after 18 days of admission.