From a sudden flood to a silent gut: a rare case report of paralytic ileus and pulmonary hemorrhage due to leptospirosis

Leptospirosis is a zoonotic disease that can cause serious complications such as a pulmonary hemorrhage and paralytic ileus. A 49-year-old man presented with symptoms of fever, myalgia, nausea, vomiting, and diarrhea after exposure to floods in Gorontalo, Indonesia. The diagnosis of leptospirosis was made based on Modified Faine's Criteria, thrombocytopenia, leukopenia, eosinophilia, impaired liver function, and positive RDT results for Leptospira IgM. On the fifth day of treatment, the patient’s condition deteriorated, presenting as shortness of breath and acute abdominal pain. Chest x-ray and BNO 3 position examination suggest pulmonary hemorrhage and paralytic ileus. The patient’s condition improved following the administration of Ceftriaxone and multidisciplinary management, including nasogastric decompression and oxygenation. This case emphasizes the importance of monitoring and early treatment of serious complications of leptospirosis.