Alveolar Hemorrhage in Weil\'s Disease and Coexisting Scrub Typhus: Fighting Two Fronts

Scrub typhus and leptospirosis may have overlapping febrile syndromes and develop to cause multiorgan dysfunction, and the coinfection can also be dangerous.In both diseases, pulmonary involvement takes place, but diffuse alveolar hemorrhage (DAH) is rare and has a high mortality rate.We describe a 59-year-old farmer presenting with high-grade fever, dyspnea, and a dry cough, who had developed hemoptysis and acute kidney injury.Laboratory analysis revealed anemia, leukocytosis, thrombocytopenia, hyperbilirubinemia, and renal insufficiency.Immunoglobulin M (IgM) testing positive for scrub typhus and leptospirosis was confirmed by serology.The chest images demonstrated diffuse infiltrates of the alveoli, which were characteristic of DAH.Supportive care, broad-spectrum antibiotics, and doxycycline led to slow recovery and discharge.The case shows that dual infections in an endemic setting should be considered and DAH recognized at early stages.Supportive measures and early serological testing can improve the outcomes with doxycycline.