Leptospirosis: An unusual cause of pulmonary haemorrhage and multi-organ failure

Dear Editor, Leptospirosis is an emerging zoonosis caused by Leptospira spp., responsible for over one million cases and nearly 60,000 deaths worldwide annually.[1] Although more common in tropical climates, sporadic cases can occur in non-endemic regions like Lebanon.[2] Infection usually follows exposure to contaminated water or soil. Clinical presentation varies from mild febrile illness to severe Weil’s disease with hepatic, renal dysfunction, and potentially fatal pulmonary involvement. We report a rare case of a healthy 44-year-old Egyptian man who presented with jaundice, lethargy, haemoptysis, and anuria. He had developed fever, headache, nausea, myalgia, vomiting, and progressive jaundice over the preceding week. He worked in a coastal seafood restaurant but denied known direct animal contact. On admission, he was afebrile, normotensive, with mild hypoxemia and diffuse icterus. Examination revealed decreased breath sounds and diffuse abdominal tenderness. Initial labs showed severe acute kidney injury (creatinine 5.8 mg/dL), thrombocytopenia (10,000/mm3), elevated bilirubin and transaminases, high CRP, and significant proteinuria. Chest radiography showed bilateral diffuse opacities, while CT confirmed ground-glass changes suggestive of alveolar haemorrhage. PCR confirmed Leptospira DNA on day 2. He was treated in the ICU with IV ceftriaxone, metronidazole, fluid resuscitation, and platelet transfusions. Despite a drop in platelets to 8,000/mm3 and worsening haemoptysis, he showed clinical and biochemical improvement over subsequent days [Table 1]. He was transferred to the general ward by day 5 and discharged home after 10 days with normalising labs.Table 1: Laboratory results over hospital stayPulmonary haemorrhage in leptospirosis, although increasingly recognised, is rare and can occur in up to 70% of severe cases, often resulting in acute respiratory failure requiring mechanical ventilation.[3-5] Our patient developed mild haemoptysis without needing supplemental oxygen or ventilation. Risk factors for severe disease include thrombocytopenia below 50,000/mm3, elevated creatinine, and raised amylase or lactate levels.[3] Early diagnosis, supported by PCR and serological tests, and prompt initiation of antibiotics can be lifesaving.[1,6] This case highlights that leptospirosis should be considered in patients with unexplained febrile illness with jaundice, AKI, and pulmonary symptoms, even in areas where it is uncommon. Early recognition and treatment remain key to preventing complications and mortality. Informed consent Patient could not be re-contacted; all identifying details have been anonymised. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Author contributions BLC: case collection, initial draft; AZ: revision and final approval. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.