746 - The Importance of Acute Rehabilitation in Critical Illness Polyneuromyopathy Secondary to Leptospirosis Infection

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

FA

Farrah Asaad, DO

Resident Physician
Icahn School of Medicine at The Mount Sinai Hospital
New York, New York, United States

Co-Author(s)

LC

Lizeth Joann Caldera, MS

Medical Student, MS-4
University of Miami Miller Medical School
Miami, Florida, United States
NN

Nancy Nguyen, MA

Medical Student
Edward Via College of Osteopathic Medicine-VCOM Auburn
Gadsden, Alabama, United States
Miguel X. Escalon, MD/MPH

Associate Professor
Icahn school of medicine at Mount Sinai
New York, New York, United States

Case Diagnosis: Critical Illness Polyneuromyopathy Secondary to Leptospira infection

Case Description: A 37-year-old male with a past medical history of hyperlipidemia presented to acute rehabilitation with right extremity motor and sensory deficits after a prolonged hospitalization due to acute respiratory distress (ARDS) secondary to a complicated leptospirosis infection. He originally presented to the emergency department at a community hospital multiple times over the course of a month with myalgia, fever, nausea, and a positive EBV test. Over the course of the month, he declined, requiring hospital admission to an ICU. He later developed sepsis, AKI, hypernatremia, and hyperbilirubinemia. An expanded infectious workup found a positive leptospirosis IgM assay which was treated with doxycycline. His hospital course was further complicated by megacolon, and ventilator acquired pneumonia requiring a tracheostomy. After extubation, the patient had profound proximal weakness, primarily in the right upper extremity, with sensory changes consistent with critical illness polyneuromyopathy (CIPNM).

Discussions: There are 100-150 yearly infections due to Leptospirosis in the US. Leptospirosis is primarily transmitted via contaminated soil, rodent infestations, and urine infected water. Complicated infections result in Weil's disease, a triad of jaundice, kidney failure, and pulmonary manifestations. Additionally, CIPNM is commonly associated with prolonged respiratory weaning, sepsis, or use of neuromuscular blocking agents and corticosteroids. After several days in acute rehabilitation, the patient progressed from moderate assist to minimal assist, regaining almost full strength in his right upper extremity. The patient was able to be discharged home with minimal supervision and continued home therapy.

Conclusions: Acute rehabilitation can aid in the quick recovery of patients diagnosed with leptospirosis along with associated complications including CIPNM.