Healthcare - West Virginia State Medical Association

Scientific Article |Leptospirosis Induced Pulmonary Alveolar HemorrhageSharjeel Ahmad, MDStaff Physician, Infectious DiseasesAssociate Director, Adult MedicineCommunity Health Services, IncHartford, CTArif R. Sarwari, MDAssociate Professor, Section ofInfectious Diseases, Department ofMedicine, West Virginia University,Morgantown, WVAbstractLeptospirosis, a zoonosis with proteanmanifestations caused by the spirocheteLeptospira interrogans, occurs worldwide.We report a case of leptospirosispresenting as pulmonary alveolarhemorrhage in a youngimmunocompetent male. This organismshould be considered as an importantinfectious cause of pulmonary alveolarhemorrhage in the appropriateepidemiological setting.BackgroundLeptospirosis, is a worldwidezoonosis with protean clinicalmanifestations caused by thespirochete Leptospira interrogans.We report a case of pulmonaryalveolar hemorrhage causedby leptospira in a youngimmunocompetent male.Case ReportA 19 year old previouslyhealthy male presented with a twoday history of cough, low gradetemperatures, frontal headache (10out of 10), photophobia, nauseaand non-bilious vomiting. Henoticed some blood on blowing hisnose but denied frank hemoptysis.Evaluation at a local emergencyroom revealed the patient to befebrile (temperature of 100.1F) withanemia, thrombocytopenia, elevatedliver enzymes, and acute renalfailure with radiological findingsconcerning for pneumonia. Hewas subsequently transferred toa tertiary care hospital for furtherevaluation and management. Thepatient also reported a rash aroundhis mouth after recent exposureto citric acid containing foods.His past medical history wassignificant for Attention DeficitHyperactivity Disorder (ADHD),allergy to sulfa medicationscausing severe rash, and allergyto “acidic” foods causing perioralrash. He was not taking anymedications on a regular basis.The patient smoked 1 pack perday for 4 years. He was drinkingmostly on weekends. He workedoff and on, doing paint jobs forconstruction companies. He had 2dogs and 2 cats as pets. He deniedany sick contact, recent travel,sexually transmitted diseases,Figure 1.Chest radiograph on admission.known tuberculosis contact, recenttick or insect bites. He did reportmultiple female sexual partners.On examination, the patientwas sitting holding his head andappeared to be in moderate distress.The blood pressure was 140/78 mmHg, pulse 100 beats per minute,temperature 36.5C, and respirations20 breaths per minute with oxygensaturation of 94% on two liters. Perioralcrusted skin lesions were presentwith no mucosal involvement. Hehad few bilateral crackles withdecreased aeration in the lowerlung zones. Photophobia waspresent with no focal neurologicaldeficits. He was alert and orientedto time, place and person.Lab work revealed a whitecell count of 14,600/µL with79% neutrophils, 5% bands, 1%20 West Virginia Medical Journal