Clinical and Medical Case Reports

Introduction: leptospirosis is a zoonotic infection which is mostly transmitted with infected water. We report a case of Guillen-barret syndrome in adults associated with leptospirosis infection.

Case Description: A 59 years old, worker of water and Sewage Company, presented to emergency room with icter, ascending paraplegia and high creatinine level. He reported influenza like symptoms 2 weeks before his current presentation. Due to his work status and symptoms, leptospirosis infection was considered and patient received doxycycline in his treatment coarse. Patients symptoms and lab test has been better however weakness and reduced DTR was persistent. Cervical spine MRI reveals disc dehydration and protrusion in C5-6. However his symptoms, due to reducing DTR and ascending weakness were more consistent with Guillen batter syndrome. The patient received IVIG and the symptoms significantly reduced.

Discussion: Based on literature, the most common neurologic manifestation of leptospirosis is aseptic meningitis however there are some reports of mononeuritis multiplex, flaccid paraplegia and a Guillen-barret in pediatric. Our case is the first report of Guillen-barret in an adult with leptospirosis.

In discussed case endoleak type III was caused by fabric defect in stentgraft wall, slow aneurysmal sac enlargement was seen in angio-CT. Standard lumbar artery and inferior mesenteric artery embolisation would be insufficient in this case. The attempt of aneurysmal sac embolisation through lumbar and mesenteric arteries with coils and polymer was hazardous in the opinion of authors. To dock the catheter via fabric defect in stentgraft wall was the shortest way and the least risky. The coils where implanted in the first step of endovascular procedure. The second step was aneurysmal sac embolisation with Glubran and Lipiodol mixture. No endoleak and no aneurysmal sac enlargement was seen in CT angiography performed two months after the procedure.

A 65-year-old female patient was found to have a nodular shadow on a chest X-ray. Computed tomography showed a well-defined tumor measuring 1.8 cm in diameter in the right middle lobe that was diagnosed to be adenocarcinoma by a transbronchial lung biopsy. The patient underwent right middle lobectomy and hilar and mediastinal lymph node dissection for stage IA primary lung cancer. The pathological diagnosis was pulmonary epithelioid hemangioendothelioma (PEH), which is a rare tumor of the lung. The postoperative course was uneventful, and she remains free of PEH recurrence at 26 months after the surgery. PEH is the currently preferred term for the neoplastic process originally described as intravascular bronchioloalveolar tumor in the lung. The estimated prevalence of epithelioid hemangioendothelioma is less than 1 in 1 million, PEH is a rare tumor derived from vascular endothelial cells, and it is difficult to diagnose it preoperatively. PEH is considered to have low-to-intermediate grade malignancy, but the tumor predominantly involves the liver, lungs, soft tissues, and can be multicentric, even resulting in systemic metastasis. We described a case of a single PEH found at a medical checkup that was treated with complete resection. Active surgical treatment is considered desirable for single cases.