A Case of Pulmonary Leptospirosis Treated with a Combination of Corticosteroid and Ceftriaxone

2015 Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi  
In leptospirosis, pulmonary involvement is the main cause of death. The survival in pulmonary leptospirosis depends on early and appropriate therapy as well as rapid diagnosis. Some immunosuppressive drugs have been known to improve survival because infectious vasculitis is responsible for the pathogenesis of pulmonary damage caused by leptospirosis. In this study, we aimed to report a case of pulmonary leptospirosis not frequently reported in our country or may be overlooked in clinical
more » ... e that was successfully treated with corticosteroids in addition to ceftriaxone therapy. A 32-year-old man presented to our hospital with fever, malaise, dry cough, shortness of breath, hemoptysis, and general muscle ache persisting for one week. He had a history of cleaning a barn with mice barefoot two weeks ago. The patient had fever, thrombocytopenia, elevated creatinine, bilirubin, and creatine kinase levels, bilateral pulmonary infi ltrates in chest radiograph, decreased peripheral saturation of hemoglobin with oxygen and epidemiological history compatible with leptospirosis. Due to high index of suspicion of pulmonary leptospirosis, high dose prednisolone was administered at the dose of 1 gr/day for the fi rst 3 days, followed by oral prednisolone 1 mg/kg/day for 7 days alongside ceftriaxone. Rapid clinical improvement was observed. The patient did not need mechanical ventilation and was discharged without sequelae. Consequently, pulmonary leptospirosis should be considered in differential diagnosis of patients with febrile illness associated with pneumonitis and respiratory failure, and it should not be forgotten that corticosteroids therapy may be lifesaving.
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