Role of high-dose corticosteroid for the treatment of leptospirosis-induced pulmonary hemorrhage.

Leptospirosis is a zoonotic disease of worldwide distribution caused by spirochetes of the genus Leptospira. Leptospirosis is a common disease, highly prevalent in human populations but most often unidentified. The International Leptospirosis Society estimates that disease incidence ranges are 0.1 to 1.0 per 100 000 in temperate climates and 10 to 100 per 100 000 in humid tropics.1 In India, outbreaks have been increasingly reported since 1980s, especially from the states of Gujarat, Kerala, Karnataka, Maharashtra, Orissa, and Tamil Nadu.2 Outbreaks mostly occur as a result of heavy rainfall and consequent flooding, usually during monsoons.3 The clinical manifestation of leptospirosis varies from inapparent infection to fulminant fatal disease. Pulmonary complications for patients with leptospirosis are also relatively common, reported in 17% to 70% of patients in several large studies.4 Although these manifestations are usually mild, recent studies suggest that pulmonary involvement is frequently the most dramatic feature of leptospiral infection. Accordingly, severe pulmonary manifestations of leptospirosis are becoming more prevalent, with pulmonary hemorrhage being the most predominant cause of death in leptospirosis. The hemorrhagic potential of leptospirosis was first reported by Weil in 1886.5 The intense intra-alveolar hemorrhages seem to be unique for leptospirosis. Previous literature on diffuse alveolar hemorrhage heavily emphasizes the causal role of vasculitides.6 Use of steroids is rarely reported in leptospirosis-associated pulmonary hemorrhages. Here, we report a case of leptospirosis with pulmonary hemorrhage that was successfully treated with a high intravenous dose of methylprednisolone.