Severe Leptospira interrogans serovar Icterohaemorrhagiae infection with hepato-renal-pulmonary involvement treated with corticosteroids

Abstract

The traditional concept of immediate antibiotic treatment in suspected leptospirosis seems to be especially important for patients up to day 4 of clinical illness. As immune mechanisms probably play a crucial role in advanced leptospirosis with presumed pulmonary hemorrhages, patients might benefit from corticosteroids or other immunosuppressive agents beside antibiotics.

Keywords: Canoeing; Leptospira interrogans; corticosteroids; hepato-pulmonary syndrome; hepato-renal syndrome; leptospirosis.

Figure 1

Course of selected laboratory parameters. Maximum values for bili_T, bili_D, AST, and ALT are shown. Prednisolone was given over a period of 19 days, initially high doses and then gradually reduced. Penicillin was administered for 10 days from day 7 after admission (start ↑) to day 17 (end ↓). ADM, admission; DIS, discharge; OPD, visit at outpatient department; biliT, total bilirubin; biliD, direct bilirubin; AST, aspartate aminotransferase; ALT, alanine aminotransferase.

Figure 2

Chest X-ray on admission. Bilateral diffuse heterogeneous airspace opacities are visible which may be indicative of hemorrhages.