Use of aminocaproic acid in combination with extracorporeal membrane oxygenation in a case of leptospirosis pulmonary hemorrhage syndrome

• Authors: Miguel Pardinas, University of Miami Miller School of Medicine; Rodrigo Mendirichaga, University of Miami Miller School of Medicine; Gaurav Budhrani, Emory University; Rajan Garg, University of Miami Miller School of Medicine; Luis Rosario, University of Miami Miller School of Medicine; Rene Rico, University of Miami Miller School of Medicine; Anthony Panos, University of Miami Miller School of Medicine; Horst Baier, University of Miami Miller School of Medicine; Stefanie Krick, University of Miami Miller School of Medicine
• Journal Title: Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine
• Volume: Volume 11
• Publisher: SAGE Publishing | 2017-03-02, Pages 1179548416686068-1179548416686068
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1177/1179548416686068
• Subjects: Health Sciences, General
• Keywords: ECMO; Leptospirosis; aminocaproic acid; pulmonary hemorrhage

Abstract

A 32-year-old man presented with a 10-day history of fever, chills, nausea, vomiting, myalgia, nonproductive cough, and worsening dyspnea after freshwater swimming in the Caribbean 1 week prior to presentation. Shortly after arrival at the hospital, the patient developed severe respiratory distress with massive hemoptysis. Based on serologic workup, he was diagnosed with leptospirosis pulmonary hemorrhage syndrome leading to diffuse alveolar hemorrhage, severe hypoxemic respiratory failure, and multiorgan failure. He received appropriate antibiotic coverage along with hemodynamic support with norepinephrine and vasopressin, mechanical ventilation, and renal replacement therapy in an intensive care unit. Introduction of extracorporeal membrane oxygenation was initiated to provide lung-protective ventilation supporting the recovery of his pulmonary function. Aminocaproic acid was used to stop and prevent further alveolar hemorrhage. He fully recovered thereafter; however, it is uncertain whether it was the use of aminocaproic acid that led to the resolution of his disease.