Use of steroids is well documented, so what is the next step of treatment of this "acute vasculitis"? What is your experience with cyclophosphamide or plasma exchange? How is the outcome?
Thanks Radovan,
I have used PLEX in severe leptospirosis with lung hemorrhages (few cases). Unfortunately the outcome was not good. Possibly the initiation is too late, and all of them succumbed due to worsening lung functions, and initial insult to the lung was massive. I am looking for experience (even in case basis) where it had been started at an earlier stage than massive hemorrhages or ARDS.
No, I'm sorry. I have not experience of this treatment in leptospirosis.
I have no experience either. I am intrigued, however by the need to use such a potent immunosuppressive agent like cyclophosphamide to treat an infectious disease; if there is a vasculitic component here then perhaps corticosteroids and other seemingly less cytotoxic agent would be in order?
Use of steroids is well documented, and stronger immunosuppressives are looked at. The pathogenesis occurs in Leptospirosis due to a florid immune reaction rather than the innocuous spirochete which is very sensitive to C.Penicillin.
Since it's the florid immune reaction that kills the patient, immunosuppressives are looked at.
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