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Stillbirth and fulminant postpartum haemolysis: COVID-19 or leptospirosis or both?

We report the case of a female patient with a SARS-CoV-2 infection first diagnosed at 32 2/7 weeks of gestation, resulting in stillbirth at 33 5/7 weeks of gestation. Post partum the patient presented with severe and persistent haemolysis, mild thrombocytopaenia, renal insufficiency and proteinuria...

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Autores principales: Sutter, Tabea, Fehr, Thomas, Blume, Carolin, Kajdi, Marie-Elisabeth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10314429/
https://www.ncbi.nlm.nih.gov/pubmed/37399345
http://dx.doi.org/10.1136/bcr-2022-252620
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author Sutter, Tabea
Fehr, Thomas
Blume, Carolin
Kajdi, Marie-Elisabeth
author_facet Sutter, Tabea
Fehr, Thomas
Blume, Carolin
Kajdi, Marie-Elisabeth
author_sort Sutter, Tabea
collection PubMed
description We report the case of a female patient with a SARS-CoV-2 infection first diagnosed at 32 2/7 weeks of gestation, resulting in stillbirth at 33 5/7 weeks of gestation. Post partum the patient presented with severe and persistent haemolysis, mild thrombocytopaenia, renal insufficiency and proteinuria as well as elevated liver enzymes and jaundice. Further investigations revealed a positive IgM for Leptospira interrogans and proof of infection by PCR in the urine. The patient was treated with penicillin for 7 days and received a total of 23 units of red blood cells within 11 days. Haemolysis diminished over time and haemoglobin, proteinuria and transaminases normalised within 23 days after delivery. We suppose an acute leptospirosis as underlying cause for the haemolysis, mimicking pregnancy-associated thrombotic microangiopathy. Whether stillbirth was related to leptospirosis or SARS-CoV-2 infection remains unclear.
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spelling pubmed-103144292023-07-02 Stillbirth and fulminant postpartum haemolysis: COVID-19 or leptospirosis or both? Sutter, Tabea Fehr, Thomas Blume, Carolin Kajdi, Marie-Elisabeth BMJ Case Rep Case Reports: Reminder of important clinical lesson We report the case of a female patient with a SARS-CoV-2 infection first diagnosed at 32 2/7 weeks of gestation, resulting in stillbirth at 33 5/7 weeks of gestation. Post partum the patient presented with severe and persistent haemolysis, mild thrombocytopaenia, renal insufficiency and proteinuria as well as elevated liver enzymes and jaundice. Further investigations revealed a positive IgM for Leptospira interrogans and proof of infection by PCR in the urine. The patient was treated with penicillin for 7 days and received a total of 23 units of red blood cells within 11 days. Haemolysis diminished over time and haemoglobin, proteinuria and transaminases normalised within 23 days after delivery. We suppose an acute leptospirosis as underlying cause for the haemolysis, mimicking pregnancy-associated thrombotic microangiopathy. Whether stillbirth was related to leptospirosis or SARS-CoV-2 infection remains unclear. BMJ Publishing Group 2023-06-30 /pmc/articles/PMC10314429/ /pubmed/37399345 http://dx.doi.org/10.1136/bcr-2022-252620 Text en © BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.
spellingShingle Case Reports: Reminder of important clinical lesson
Sutter, Tabea
Fehr, Thomas
Blume, Carolin
Kajdi, Marie-Elisabeth
Stillbirth and fulminant postpartum haemolysis: COVID-19 or leptospirosis or both?
title Stillbirth and fulminant postpartum haemolysis: COVID-19 or leptospirosis or both?
title_full Stillbirth and fulminant postpartum haemolysis: COVID-19 or leptospirosis or both?
title_fullStr Stillbirth and fulminant postpartum haemolysis: COVID-19 or leptospirosis or both?
title_full_unstemmed Stillbirth and fulminant postpartum haemolysis: COVID-19 or leptospirosis or both?
title_short Stillbirth and fulminant postpartum haemolysis: COVID-19 or leptospirosis or both?
title_sort stillbirth and fulminant postpartum haemolysis: covid-19 or leptospirosis or both?
topic Case Reports: Reminder of important clinical lesson
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10314429/
https://www.ncbi.nlm.nih.gov/pubmed/37399345
http://dx.doi.org/10.1136/bcr-2022-252620
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