An Interesting Case of Leptospirosis with Pulmonary Syndrome

Objective: To report a case of leptospirosis with pulmonary syndrome.

Background data: Leptospirosis is one of the most common zoonotic disease occurring worldwide, Leptospira interrogans being the pathogenic spirochete for humans. The spread occurs mostly during the monsoons. It enters the human skin through cuts and abrasions, while rats are the frequent hosts. Leptospirosis is associated with a wide range of syndromes such as bacteraemic leptospirosis which infests as a non-specific illness and conjunctival congestion is the only physical sign. Aseptic meningitis is another manifestation with a neutrophil leucocytosis and abnormal LFTs. Weil’s disease (icteric leptospirosis), is a life-threatening event which presents with hepatic and renal involvement along with haemorrhage and a macular rash. Involvement of lungs leads to pulmonary syndrome which is characterised by haemoptysis, patchy lung infiltrates on chest xray, ARDS with MODS.

Case: A 32 year old male, butcher by profession, had complaints of fever since the past 10 days, which was high grade, intermittent and associated with chills and rigor, for which he went to a local hospital where he was prescribed some medications and was found to have a low haemoglobin level. His symptoms relieved in 2 days after which he noticed yellowish discolouration of eyes and a high coloured urine for which he did not consult a doctor. Four days following this episode, he started having cough and shortness of breath, which was progressive. Now, he presented to the casualty for the same and one episode of melena last night. On investigating further, he was found to have increased counts, altered LFTs, and USG Abdomen showed increased echogenicity of kidneys with normal size. Peripheral smear showed toxic granulations and no parasites were found. His viral markers and NS1 antigen were negative. He was started on NIV support, Inj. Ceftriaxone 1g BD, Inj. Azithromycin 500mg BD and symptomatic treatment was given. Since the patient’s condition did not improve in 3 days, leptospira IgM was sent which came out positive with a titre of 1:400. Patient was then started on doxycycline.