The Successful Management of Severe Leptospirosis by Using Meropenem and Corticosteroids in the Setting of Multi-Drug Hypersensitivity: A Case Report

Leptospirosis is a globally significant zoonotic infection that poses a major burden on tropical regions. It is often misdiagnosed due to its highly variable clinical spectrum. Although severe leptospirosis is classically characterized by jaundice, acute kidney injury (AKI), and severe pulmonary hemorrhage syndrome (SPHS), atypical anicteric presentations pose diagnostic challenges and delay treatment initiation, increasing mortality risk. We report the case of a 23-year-old female with severe leptospirosis, which presented a significant therapeutic challenge due to hypersensitivity to all first-line antimicrobial agents for leptospirosis, limiting treatment options. Her clinical course was further complicated by the development of SPHS, septic shock, AKI, and severe thrombocytopenia, necessitating critical care support. Interestingly, she had no signs of jaundice or severe hepatic dysfunction. Initial broad-spectrum therapy with piperacillin-tazobactam failed to achieve clinical improvement. Given her worsening clinical condition, antimicrobial therapy was escalated to meropenem alongside methylprednisolone, which led to the progressive resolution of her pulmonary and renal dysfunction within 48 hours. This report highlights the potential efficacy of meropenem as an alternative antimicrobial therapy for leptospirosis when first-line antibiotics are contraindicated, and supports the role of corticosteroids in leptospirosis-associated pulmonary complications. It also underscores the significance of maintaining a high index of clinical suspicion in high-risk populations to facilitate early diagnosis and antibiotic initiation to improve outcomes in atypical presentations.