A leptospirosis case presenting with thrombotic thrombocytopenic purpura.

Background: Leptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira. While the majority of leptospirosis cases occur in the tropics, some cases are also observed in temperate regions of developing countries. The disease has various clinical presentations ranging from a mild influenza-like form to a severe potentially fatal illness accompanied by multi-organ failure. However, atypical presentations of leptospirosis have occasionsally been described. Here, a case of leptospirosis presenting as thrombotic thrombocytopenic purpura (TTP) is reported. Case Report: A 58-years-old male presented with fever, oliguria, darkening of urine, and visual hallucinations. Laboratory investigations revealed anaemia, severe thrombocytopaenia, elevated total bilirubin with indirect predominance, high lactate dehydrogenase, and increased urea (293 mg/dL) and creatinine (7.6 mg/dL) levels. He was diagnosed with TTP. Patient was thought leptospirosis due to atypical clinical manifestations. Leptospirosis was confirmed by strongly positive Microscopic Agglutination Test. Patient recovered completely with antibiotics and plasmapheresis. Conclusion: Leptospirosis may be accompanied by thrombotic thrombocytopenic purpura in particular subtropic regions. Turkish Baslik:Trombotik Trombositopenik Purpurayla Seyreden Bir Leptospiroz Olgusu Anahtar Kelimeler:Leptospiroz, Weil hastaligi, trombotik trombositopenik purpura Arkaplan: Leptospiroz, leptospira cinsi spiral mikroorganizmalar tarafindan olusturulan bir zoonozdur. Leptospiroz siklikla tropikal bolgelerde gorulmesine ragmen, gelismekte olan ulkelerde iliman bolgelerde de rastlanabilmektedir. Hastalik asemptomatik enfeksiyondan ciddi, olumcul seyredebilen coklu organ yetmezligine kadar genis klinik yelpaze gorulur. Bununla birlikte atipik basvuru nadiren gorulmektedir Olgu Sunumu: Elli sekiz yasinda erkek olgu ates yuksekligi, idrar renginde koyulasma ve gorsel halusinasyonla basvurdu. Laboratuvar incelemesinde anemi, ciddi trombositopeni,indirek hakimiyeti olan bilirubin yuksekligi, yuksek laktat dehidrogenaz, yuksek ure (293 mg/dL) ve kreatinin (7.6 mg/dL) duzeyleri mevcuttu. TTP tanisi aldi. Atipik klinik sekilli leptospiroz dusunuldu. Leptospirozis tanisi yuksek pozitif mikroskopik aglutinasyon testi ile dogrulandi. Hasta antibiyotik tedavisi ve plazmaferezle tamamen iyilesti. Sonuc: Ozellikle subtropik bolgelerde, leptospiroz trombotik trombositopenik purpurayla birliktelik gosterebilir.