Leptospiral pulmonary hemorrhagic syndrome as a severe complication of Weil’s disease: A case report

Abstract

Leptospirosis is a globally distributed zoonotic disease caused by Leptospira spirochetes, often leading to severe complications, such as Weil’s disease and leptospiral pulmonary hemorrhagic syndrome (LPHS). LPHS is particularly lethal, with mortality rates ranging from 40% to 60% due to acute respiratory failure. A 41-year-old male presented with a 4-day history of high fever, severe myalgia (notably in the calves), headache, and nausea following recent exposure to floodwaters and rodents. Physical examination revealed jaundice, tachycardia, tachypnea, and gastrocnemius tenderness. Initial laboratory findings showed leukocytosis, severe thrombocytopenia (34,000/μL), and significant hepatorenal dysfunction (creatinine 6.7 mg/dL, elevated liver enzymes). Despite aggressive therapy, including broad-spectrum antibiotics, hemodialysis, and blood product transfusions, the patient’s condition deteriorated. He developed bilateral subconjunctival hemorrhage and pulmonary edema. Diagnostic confirmation was achieved through a positive Leptospira IgM and a microscopic agglutination test titer of 1:640. The patient ultimately succumbed to septic shock and multi -organ failure on the 11th day of hospitalization. This case underscores the rapid and often fatal progression of LPHS in the context of Weil’s disease. Early clinical suspicion based on epidemiological factors (e.g., flood exposure) and prompt initiation of intensive supportive care are critical, although the prognosis remains poor once severe pulmonary hemorrhage and multi -organ dysfunction develop.