Hippokratia 2006; 10(2): 92-93
C Katsanoulas, H Mouloudi, C Lampiri, M Assimaki, N Gritsi-Gerogianni
General Intensive Care Department, Hippokratio Hospital, Thessaloniki, Greece
Alveolar haemorrhage due to pulmonary vasculitis in the course of leptospirosis, although not uncommon, is rarely included in the differential diagnosis of pulmonary haemorrhagic syndromes. We present a case of a patient, treated in the ICU for leptospira infection, with a late onset of diffuse alveolar haemorrhage. A 68-year-old man was transferred in the ICU after a progressive CNS impairment. His lab tests were indicative for a severe hepatic dysfunction and renal impairment in need of intermittent haemodialysis. A presumptive diagnosis of leptospirosis was done, confirmed later by positive serologies. At the end of the icteric phase and while weaning from mechanical ventilation, multiple episodes of haemoptysis started, resulting in severe deterioration of oxygenation. Chest X-ray showed new bilateral patchy infiltrates and a High Resolution Computed Tomography scan revealed diffuse airspace disease with bilateral ground-glass opacities. Methylprednisolone 1g daily for 3 days, followed by prednisolone, 20 mg every 6 hours, was given. The patient responded with bleeding cessation and successful weaning. Twelve days later he was discharged to the ward improved. Haemorrhagic alveolitis usually occurs at the after the “leptospiremic” period of the disease. The case presented is suggestive of a delayed, post-”immune” onset of symptoms responding well to high dose steroid therapy.
Keywords: leptospirosis, alveolar haemorrhage, vasculitis, steroids