The New Indian Journal of OBGYN. 10(2):446-449

A rare case of Weil’s disease in pregnancy - a case report

Anusha Ginjupalli, Naimisha Movva, Rajkumar Owk, Ravi Gowda

ABSTRACT

Leptospirosis is a rare zoonotic disease caused by spirochaete of the genus Leptospira. About 5-10% of patients manifest as severe disease known as Weil’s disease associated with high fatality. Infection in pregnancy is uncommon and moreover it may mimic viral hepatitis, acute fatty liver in pregnancy (AFLP), pregnancy induced hypertension (PIH) and HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome. A 23 year old, primigravida (34 weeks gestation) who is Rh negative and not in labour was referred to our hospital in view of persistent hypotension and bradycardia. Prior to this, patient had complaints of swelling of lower limbs since 15 days and cough with expectoration, sore throat and dysphagia, fever 1 week ago followed by jaundice, epistaxis and hematochezia. Patient had blood pressure recording of 80/40 mm Hg, pulse -40bpm on admission. On further evaluation she was negative for dengue, malaria but leptospira positive. She was severely anemic with deranged hepatic and renal functions and diagnosed to be disseminated intravascular coagulation (DIC) with decompensatory shock. Preterm lower segment caesarean section (PTLSCS) was done in view of failed induction and a fresh still born baby of weight 2.2 kg was extracted. Patient had severe postpartum hemorrhage (PPH) and due to failed medical management, stepwise devascularisation was performed followed by peripartum hysterectomy and was shifted to ventilator due to persistent hypotension. On the postoperative day 2, patient blood pressure did not pick up and patient died of DIC complications. In pregnant women, early identification of the disease is required to avoid complications as well as fetal and maternal mortality.