{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:36:13Z","timestamp":1787016973991,"version":"build-2736575974"},"reference-count":25,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,5,8]]},"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:p>\n                    A 47-year-old man with a recent history of wading in floodwaters presented with a 1-week history of cough, myalgia, conjunctival suffusion and decreasing urine output. The patient had uraemia, hypotension, leukocytosis, thrombocytopenia, elevated liver enzymes and oliguria. His condition quickly worsened with haemoptysis, and respiratory distress which subsequently required intubation and mechanical ventilation. Continuous renal replacement therapy was started together with haemoperfusion (HP). The patient initially required norepinephrine and this was discontinued after the first session of HP. He was referred for veno-venous extracorporeal membrane oxygenation (ECMO) due to severe hypoxia and pulmonary haemorrhage. Oxygenation and lung compliance improved, and serum creatinine levels continued to normalise with improved urine output. He was placed off ECMO, extubated and eventually discharged. Patient was diagnosed with severe leptospirosis, acute respiratory failure and acute kidney injury successfully treated with simultaneous ECMO and HP. Blood samples were positive for\n                    <jats:italic>Leptospira<\/jats:italic>\n                    spp. DNA via PCR assay.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2019-229582","type":"journal-article","created":{"date-parts":[[2019,5,30]],"date-time":"2019-05-30T06:34:15Z","timestamp":1559198055000},"page":"e229582","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["A case of leptospirosis with acute respiratory failure and acute kidney injury treated with simultaneous extracorporeal membrane oxygenation and haemoperfusion"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3686-417X","authenticated-orcid":false,"given":"Joselito R","family":"Chavez","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Metro Manila, Philippines"},{"name":"Section of Pulmonary Medicine, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Metro Manila, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romina A","family":"Danguilan","sequence":"additional","affiliation":[{"name":"Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Metro Manila, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melhatra I","family":"Arakama","sequence":"additional","affiliation":[{"name":"Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Metro Manila, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joann Kathleen Ginete","family":"Garcia","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Metro Manila, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rizza","family":"So","sequence":"additional","affiliation":[{"name":"Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Metro Manila, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Chua","sequence":"additional","affiliation":[{"name":"Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Metro Manila, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,5,29]]},"reference":[{"key":"2025082711504694000_12.5.e229582.1","first-page":"5","article-title":"Predictors of Dialytic Management and Mortality among Leptospirosis Patients with Acute Renal Failure at the National Kidney and Transplant Institute","volume":"2","author":"Ginete","year":"2012","journal-title":"Journal of Nephrology and Therapeutics"},{"key":"2025082711504694000_12.5.e229582.2","first-page":"161","article-title":"Outcome of Adults with Leptospirosis and Renal Failure Treated with Pulse Immunosuppression","volume":"4","author":"Pasamba","year":"2018","journal-title":"J Kidney"},{"key":"2025082711504694000_12.5.e229582.3","doi-asserted-by":"crossref","first-page":"171","DOI":"10.4172\/2329-9088.1000171","article-title":"Effect of Methylprednisolone and Cyclophosphamide on the Survival of Patients with Leptospirosis, Renal Failure and Pulmonary Hemorrhage","volume":"02","author":"Manipol-Larano","year":"2014","journal-title":"Trop Med Surg"},{"key":"2025082711504694000_12.5.e229582.4","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s13054-017-1662-9","article-title":"Hemoadsorption by CytoSorb in septic patients: a case series","volume":"21","author":"Kogelmann","year":"2017","journal-title":"Crit Care"},{"key":"2025082711504694000_12.5.e229582.5","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318170b9a7"},{"key":"2025082711504694000_12.5.e229582.6","unstructured":"Leptospirosis Guidelines 2010 [Internet]. 2010 https:\/\/www.pcp.org.ph (cited 25 Jan 2019)."},{"key":"2025082711504694000_12.5.e229582.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2010.07.002"},{"key":"2025082711504694000_12.5.e229582.8","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1590\/S0037-86822002000400017","article-title":"Clinicopathological and immunohistochemical features of the severe pulmonary form of leptospirosis","volume":"35","author":"Silva","year":"2002","journal-title":"Rev Soc Bras Med Trop"},{"key":"2025082711504694000_12.5.e229582.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60647-9"},{"key":"2025082711504694000_12.5.e229582.10","doi-asserted-by":"publisher","DOI":"10.1097\/01.qco.0000178824.05715.2c"},{"key":"2025082711504694000_12.5.e229582.11","unstructured":"Dohgovph. 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