A Case of Leptospirosis Induced Acute Respiratory Distress Syndrome

Document Type

Conference Proceeding

Publication Date

5-18-2025

Publication Title

Am J Respir Crit Care Med

Abstract

INTRODUCTION: Leptospirosis is an infection that is often overlooked due to its low incidence in the United States, especially in cooler climates. It is also underdiagnosed due to its mild clinical course in many patients. We present a case of severe leptospirosis in a patient presenting with sepsis and multiorgan involvement. CASE: A 66-year-old female with a past medical history of hyperlipidemia presented with a five-day history of fatigue, chills, nausea, and vomiting. She was found to be tachycardic, tachypneic, febrile, and hypoxic initially requiring 2 liters via nasal cannula. Her preliminary workup was significant for hyponatremia, acute kidney injury, transaminitis, hyperbilirubinemia, and thrombocytopenia. Urinalysis and creatinine kinase were consistent with rhabdomyolysis. Her chest x-ray was unremarkable, with computed tomography (CT) abdomen and pelvis showing tree-in-bud nodules in the lung bases. She was started on antibiotics, however continued to worsen and was admitted to the medical intensive care unit. Her oxygen requirements continued to escalate, up to 30 liters via heated high-flow nasal cannula. CT chest showed interval worsening of diffuse lung disease with bilateral ground glass opacities and septal thickening concerning for acute respiratory distress syndrome (ARDS). Her PaO2/FiO2 ratio was 146, suggestive of moderate severity ARDS. An extensive workup by multiple specialties did not reveal the cause of her overall clinical picture, with respiratory viral panel, legionella, autoimmune liver panel, and multiple myeloma testing all negative. On hospital day four, it was noted that the patient was a gardener and had recently cleaned out rat traps around her garden. Antibiotics were changed to ceftriaxone and azithromycin due to concern for leptospirosis, with a positive IgM confirming the high clinical suspicion of our infectious disease team. She completed antibiotic therapy with continued improvement in her oxygen requirements, creatinine, thrombocytopenia, and bilirubin. A repeat chest x-ray done one week after discharge showed no abnormality. DISCUSSION: This patient presented with a constellation of symptoms classic for icteric leptospirosis, including jaundice, renal failure, thrombocytopenia, and ARDS. In addition, she was found to have known risk factors of rodent and contaminated soil exposure while gardening. Of note, this patient was originally on ampicillin-sulbactam and changed to ceftriaxone once there was suspicion for leptospirosis. Placing leptospirosis on the differential as well as taking a detailed social history in similar cases may allow for earlier diagnosis and more targeted antibiotic therapy.

Volume

211

First Page

1

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