{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T08:21:18Z","timestamp":1783498878336,"version":"3.55.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,3]],"date-time":"2021-06-03T00:00:00Z","timestamp":1622678400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,3]],"date-time":"2021-06-03T00:00:00Z","timestamp":1622678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Leptospirosis is a zoonotic spirochetal disease caused by <jats:italic>Leptospira interrogans<\/jats:italic>. The clinical presentation ranges from an asymptomatic state to a fatal multiorgan dysfunction. Neurological manifestations including aseptic meningitis, spinal cord and peripheral nerve involvement, cranial neuropathies and cerebellar syndrome are well recognized with varying frequencies among patients with this disease. Posterior reversible encephalopathy syndrome is a very rare occurrence in leptospirosis and only two cases are reported in the medical literature up to now. We report a case of posterior reversible encephalopathy syndrome in a patient with leptospirosis with rhabdomyolysis and acute kidney injury.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 21\u2009year-old male presented with fever and oliguric acute kidney injury with rhabdomyolysis. A diagnosis of leptospirosis was made and he was being managed according to the standard practice together with regular hemodialysis. The clinical condition was improving gradually. On day 8 of the illness, he developed headache and sudden painless complete bilateral vision loss followed by several brief generalized tonic clonic seizure attacks. Examination was significant for a Glasgow Coma Scale of 14\/15, blood pressure of 150\/90\u2009mmHg and complete bilateral blindness. The findings of magnetic resonance imaging of the brain were compatible with posterior reversible encephalopathy syndrome. He was managed with blood pressure control and antiepileptics with supportive measures and standard treatment for leptospirosis and made a complete recovery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Posterior reversible encephalopathy syndrome, though very rare with leptospirosis, should be considered as a differential diagnosis in a patient with new onset visual symptoms and seizures, especially during the immune phase. Optimal supportive care together with careful blood pressure control and seizure management would yield a favourable outcome in this reversible entity.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-06240-2","type":"journal-article","created":{"date-parts":[[2021,6,3]],"date-time":"2021-06-03T12:04:21Z","timestamp":1622721861000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A rare case of posterior reversible encephalopathy syndrome in a patient with severe leptospirosis complicated with rhabdomyolysis and acute kidney injury; a case report"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9289-1960","authenticated-orcid":false,"given":"Jayawardane Pathiranage Roneesha","family":"Lakmali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanapathipillei","family":"Thirumavalavan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danapala","family":"Dissanayake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,3]]},"reference":[{"issue":"2","key":"6240_CR1","doi-asserted-by":"publisher","first-page":"167","DOI":"10.7326\/0003-4819-79-2-167","volume":"79","author":"SJ Berman","year":"1973","unstructured":"Berman SJ, Tsai CC, HOLMES K, Fresh JW, Watten RH. Sporadic anicteric leptospirosis in South Vietnam: a study in 150 patients. Ann Intern Med. 1973;79(2):167\u201373. https:\/\/doi.org\/10.7326\/0003-4819-79-2-167.","journal-title":"Ann Intern Med"},{"issue":"3","key":"6240_CR2","first-page":"179","volume":"51","author":"AM Bal","year":"2005","unstructured":"Bal AM. Unusual clinical manifestations of leptospirosis. J Postgrad Med. 2005;51(3):179\u201383.","journal-title":"J Postgrad Med"},{"key":"6240_CR3","first-page":"2019","volume":"17","author":"WD Priyankara","year":"2019","unstructured":"Priyankara WD, Manoj EM. Posterior reversible encephalopathy in a patient with severe leptospirosis complicated with pulmonary Haemorrhage, myocarditis, and acute kidney injury. Case Rep Crit Care. 2019;17:2019.","journal-title":"Case Rep Crit Care"},{"issue":"11","key":"6240_CR4","doi-asserted-by":"publisher","first-page":"e40","DOI":"10.1136\/jnnp.2010.226340.91","volume":"81","author":"J Aram","year":"2010","unstructured":"Aram J, Cockerell OC, Evanson J. POC21 posterior reversible encephalopathy syndrome in a case of leptospirosis. J Neurol Neurosurg Psychiatry. 2010;81(11):e40.","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"7","key":"6240_CR5","first-page":"1199","volume":"21","author":"SO Casey","year":"2000","unstructured":"Casey SO, Sampaio RC, Michel E, Truwit CL. Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. Am J Neuroradiol. 2000;21(7):1199\u2013206.","journal-title":"Am J Neuroradiol"},{"key":"6240_CR6","first-page":"5057","volume":"76","author":"FP Doeleman","year":"1932","unstructured":"Doeleman FP, van Weil Z. Rechstreeks overgebracht van mensch op mensch. Ned Tijdschr Geneeskd. 1932;76:5057.","journal-title":"Ned Tijdschr Geneeskd"},{"issue":"1","key":"6240_CR7","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1093\/infdis\/158.1.246","volume":"158","author":"CA Bolin","year":"1988","unstructured":"Bolin CA, Koellner P. Human-to-human transmission of Leptospira interrogans by milk. J Infect Dis. 1988;158(1):246\u20137. https:\/\/doi.org\/10.1093\/infdis\/158.1.246.","journal-title":"J Infect Dis"},{"key":"6240_CR8","unstructured":"World Health Organization. Report of the second meeting of the leptospirosis burden epidemiology reference group."},{"issue":"1","key":"6240_CR9","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1186\/s12879-018-3655-y","volume":"19","author":"J Warnasekara","year":"2019","unstructured":"Warnasekara J, Koralegedara I, Agampodi S. Estimating the burden of leptospirosis in Sri Lanka; a systematic review. BMC Infect Dis. 2019;19(1):119. https:\/\/doi.org\/10.1186\/s12879-018-3655-y.","journal-title":"BMC Infect Dis"},{"key":"6240_CR10","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/978-3-662-45059-8_5","volume":"387","author":"DA Haake","year":"2015","unstructured":"Haake DA, Levett PN. Leptospirosis in humans. Curr Top Microbiol Immunol. 2015;387:65\u201397. https:\/\/doi.org\/10.1007\/978-3-662-45059-8_5.","journal-title":"Curr Top Microbiol Immunol"},{"issue":"4","key":"6240_CR11","doi-asserted-by":"publisher","first-page":"904","DOI":"10.2214\/AJR.07.2024","volume":"189","author":"AM McKinney","year":"2007","unstructured":"McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. Am J Roentgenol. 2007;189(4):904\u201312. https:\/\/doi.org\/10.2214\/AJR.07.2024.","journal-title":"Am J Roentgenol"},{"issue":"5","key":"6240_CR12","doi-asserted-by":"publisher","first-page":"427","DOI":"10.4065\/mcp.2009.0590","volume":"85","author":"JE Fugate","year":"2010","unstructured":"Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010;85(5):427\u201332.","journal-title":"Mayo Clin Proc"},{"issue":"3","key":"6240_CR13","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1080\/00034983.1987.11812114","volume":"81","author":"T de Brito","year":"1987","unstructured":"de Brito T, Morais CF, Yasuda PH, Lancellotti CP, Hoshino-Shimizu S, Yamashiro E, et al. Cardiovascular involvement in human and experimental leptospirosis: pathologic findings and immunohistochemical detection of leptospiral antigen. Ann Trop Med Parasitol. 1987;81(3):207\u201314. https:\/\/doi.org\/10.1080\/00034983.1987.11812114.","journal-title":"Ann Trop Med Parasitol"},{"issue":"8","key":"6240_CR14","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1007\/s00415-016-8377-8","volume":"264","author":"M Fischer","year":"2017","unstructured":"Fischer M, Schmutzhard E. Posterior reversible encephalopathy syndrome. J Neurol. 2017;264(8):1608\u201316. https:\/\/doi.org\/10.1007\/s00415-016-8377-8.","journal-title":"J Neurol"},{"issue":"4","key":"6240_CR15","first-page":"394","volume":"30","author":"WJ Kim","year":"2011","unstructured":"Kim WJ, Park SK, Choi HY, Ha SK, Park HC. Rhabdomyolysis-induced acute kidney injury associated with posterior reversible encephalopathy syndrome. Korean J Nephrol. 2011;30(4):394\u20138.","journal-title":"Korean J Nephrol"},{"issue":"8","key":"6240_CR16","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1111\/j.1365-2044.2011.06752.x","volume":"66","author":"RA Fearnley","year":"2011","unstructured":"Fearnley RA, Lines SW, Lewington AJ, Bodenham AR. Influenza A-induced rhabdomyolysis and acute kidney injury complicated by posterior reversible encephalopathy syndrome. Anaesthesia. 2011 Aug;66(8):738\u201342. https:\/\/doi.org\/10.1111\/j.1365-2044.2011.06752.x.","journal-title":"Anaesthesia."}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06240-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-021-06240-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06240-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,3]],"date-time":"2021-06-03T12:04:42Z","timestamp":1622721882000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-021-06240-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,3]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["6240"],"URL":"https:\/\/doi.org\/10.1186\/s12879-021-06240-2","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,3]]},"assertion":[{"value":"14 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed written consent was obtained from the patient for publishing the personal and clinical details including images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they do not have any competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"522"}}