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This case highlights the management of severe pulmonary hemorrhage due to leptospirosis using VV-ECMO.

May 20, 2026

A102-04 VV ECMO as Rescue Therapy for Leptospirosis Induced Pulmonary Hemorrhage: Hawaii’s First Reported Case

SKS KondoUniversity of Hawaiʻi at Mānoa EGE A GanitanoStraub Medical Center ACA CorpuzUniversity of Hawaiʻi at Mānoa

Key Points

This case highlights the management of severe pulmonary hemorrhage due to leptospirosis using VV-ECMO.
A 30-year-old male with occupational exposure was treated after developing severe respiratory distress.
Initial treatments included antibiotics and corticosteroids, followed by VV-ECMO on hospital day 2.
Patient underwent serial bronchoscopies to clear thick secretions.
Patient was successfully decannulated from VV-ECMO on hospital day 5.
Full recovery of renal, liver, and pulmonary functions occurred by hospital day 15.
Significant improvements were noted after VV-ECMO once conventional management was insufficient.

Abstract

Abstract Introduction Compared to the United States, Hawaii reports the highest incidence of leptospirosis with recent studies estimating 2.71 cases per 100,000 population annually in Hawaii. While leptospirosis typically presents as a mild febrile illness with gastrointestinal symptoms, severe pulmonary hemorrhage syndrome (SPHS) represents a rare, high-mortality manifestation. We present Hawaii’s first case of leptospirosis-induced SPHS managed with veno-venous extracorporeal membrane oxygenation (VV-ECMO). Case Presentation A 30-year-old male arborist from rural Hawaii with occupational exposure to dust, insects, and rodents presented after four days of headache, fatigue, abdominal discomfort, and diarrhea. On admission he was found to have acute renal failure, hyperbilirubinemia, thrombocytopenia, and had extensive bilateral pulmonary infiltrates on chest CT. A comprehensive infectious workup was negative except for positive Leptospira IgM, confirming a diagnosis of icteric leptospirosis. Although treated with intravenous antibiotics and corticosteroids, his respiratory status rapidly deteriorated to severe acute respiratory distress syndrome (ARDS) that was unresponsive to neuromuscular blockade and prone positioning. Bronchoscopy revealed bilateral pulmonary hemorrhage. Despite maximal lung protective ventilation, the patient developed refractory hypercapnic respiratory acidosis with a pH of 7.05 and PaCO2 of 76 mmHg, prompting initiation of VV-ECMO on hospital day 2. Following clearance of thick serosanguinous secretions through serial bronchoscopies, the patient was successfully decannulated from VV-ECMO on hospital day 5. He was discharged on hospital day 15 with recovery of renal, liver, and pulmonary function. Discussion Leptospirosis with SPHS should be strongly considered in patients from endemic areas who present with pulmonary hemorrhage, fever, hyperbilirubinemia, and renal failure. This rare condition can be fatal without early diagnosis, targeted antibiotic therapy, and end organ support. VV-ECMO should be considered as a valuable adjunct treatment option when conventional management of ARDS fails. This abstract is funded by: None

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