[Case report: 38-year-old male with hemoptysis, jaundice and acute kidney injury].

Abstract

Globally, leptospirosis represents one of the most common zoonotic diseases, with approximately 1 million cases reported annually. It predominantly occurs in tropical and subtropical regions. In light of climate change, raising awareness of such diseases among clinicians in moderate climate zones might become increasingly important.We report the following case of a hybrid presentation of leptospirosis, characterized by predominant pulmonary involvement in the form of diffuse alveolar hemorrhage, as well as jaundice and nephritis.A 38-year-old patient presented one week after a summer riverside barbecue with fever and jaundice. Laboratory tests revealed elevated CRP and procalcitonin levels, direct hyperbilirubinemia and acute kidney injury. The following day he developed diffuse alveolar hemorrhage with rapidly progressive respiratory failure and the need for invasive ventilation. Serological testing for Leptospira was positive and the diagnosis was further confirmed by PCR.With supportive measures and anti-infective therapy with ceftriaxone the patient's condition progressively improved. After 8 days of invasive ventilation he was successfully extubated.This case highlights the importance of considering a broader differential diagnosis in complex and severe disease presentations. Despite the currently sporadic occurrence of this disease in Germany, leptospirosis should be considered in cases of pulmonary hemorrhage in conjunction with kidney failure and jaundice.