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Case Reports: Reminder of important clinical lesson
Stillbirth and fulminant postpartum haemolysis: COVID-19 or leptospirosis or both?
  1. Tabea Sutter1,
  2. Thomas Fehr2,
  3. Carolin Blume3 and
  4. Marie-Elisabeth Kajdi1
  1. 1Department of Intensive Care, Kantonsspital Graubunden, Chur, Switzerland
  2. 2Department of Internal Medicine, Kantonsspital Graubunden, Chur, Switzerland
  3. 3Department of Obstetrics and Gynecology, Kantonsspital Graubunden, Chur, Switzerland
  1. Correspondence to Dr Marie-Elisabeth Kajdi; marie-elisabeth.kajdi{at}ksgr.ch

Abstract

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.

  • COVID-19
  • Abortion
  • Infections
  • Haematology (incl blood transfusion)

https://doi.org/10.1136/bcr-2022-252620

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: TS, M-EK, TF and CB. The following authors gave final approval of the manuscript: TS, M-EK, TF and CB.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.