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

Tabea Sutter; Thomas Fehr; Carolin Blume; Marie-Elisabeth Kajdi

doi:10.1136/bcr-2022-252620

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

BMJ Case Rep. 2023 Jun 30;16(6):e252620. doi: 10.1136/bcr-2022-252620.

Authors

Tabea Sutter¹, Thomas Fehr², Carolin Blume³, Marie-Elisabeth Kajdi⁴

Affiliations

¹ Department of Intensive Care, Kantonsspital Graubunden, Chur, Switzerland.
² Department of Internal Medicine, Kantonsspital Graubunden, Chur, Switzerland.
³ Department of Obstetrics and Gynecology, Kantonsspital Graubunden, Chur, Switzerland.
⁴ Department of Intensive Care, Kantonsspital Graubunden, Chur, Switzerland marie-elisabeth.kajdi@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.

Keywords: Abortion; COVID-19; Haematology (incl blood transfusion); Infections.

Publication types

Case Reports

MeSH terms

COVID-19* / complications
Female
Hemolysis
Humans
Leptospirosis* / complications
Leptospirosis* / diagnosis
Leptospirosis* / drug therapy
Postpartum Period
Pregnancy
Proteinuria
SARS-CoV-2
Stillbirth