Methylprednisolone-Responsive Leptospiral Acute Pulmonary Syndrome: A Case Report
Keywords:Fever, Hemoptysis, Leptospirosis, Methylprednisolone, Agglutination, Tests
Background: Leptospirosis is an infectious disease caused by the spirochete of the genus leptospira. It is thought to be the most common zoonosis globally and has a wide range of clinical presentations with pulmonary hemorrhage being one of its most severe manifestations. This entity known as acute pulmonary syndrome carries a high fatality rate. However, it can be effectively managed with methylprednisolone therapy.
Case: We report a case of leptospirosis in a 26-year-old Bangladeshi male who was otherwise healthy. He presented with a 7-day history of fever with chills and rigors, and hemoptysis for a duration of 2 days. Physical examination revealed a febrile and lethargic man. Respiratory examination exhibited bilateral generalized crepitations over the lung fields. A chest radiograph performed showed bilateral alveolar shadowing. The diagnosis of leptospirosis was made based on positive Immunoglobulin M enzyme-linked immunosorbent assay serology, which was then confirmed by the microscopic agglutination test for leptospirosis. The patient was commenced on intravenous antibiotics and methylprednisolone at this time. He responded well clinically with resolution of fever and hemoptysis and a marked decrease in crepitations upon auscultation. This correlated with radiological improvement evidence by an obvious reduction in alveolar shadowing on subsequent chest radiograph 2 days later.
Conclusion: This case is highly pertinent to the medical field as leptospirosis is an ever-growing problem and acute pulmonary syndrome is an emerging manifestation of it. Therefore, early recognition and intervention is required as this can be effectively treated with methylprednisolone therapy even in resource-limited settings
2. Gulati S, Gulati A. Pulmonary manifestations of leptospirosis. Lung India. 2012 Oct;29(4):347-53.
3. Shenoy VV, Nagar VS, Chowdhury AA, Bhalgat PS, Juvale NI. Pulmonary leptospirosis: an excellent response to bolus methylprednisolone. Postgrad Med J. 2006 Sep;82(971):602-6.
4. Levett PN. Leptospirosis. Clin Microbiol Rev. 2001 Apr;14(2):296-326.
5. Natarajaseenivasan K, Raja V, Narayanan R. Rapid diagnosis of leptospiro¬sis in patients with different clinical manifestations by 16S rRNA gene based nested PCR. Saudi J Biol Sci. 2012 Apr;19(2):151-5.
6. Gouveia EL, Metcalfe J, de Carvalho AL, Aires TS, Villasboas-Bisneto JC, Queirroz A et al. Leptospirosis-associated severe pulmonary hemorrhagic sy¬ndrome, Salvador, Brazil. Emerg Infect Dis. 2008 Mar;14(3):505-8.
7. Croda J, Neto AN, Brasil RA, Pagliari C, Nicodemo AC, Duarte MI. Leptospi¬rosis pulmonary haemorrhage syndrome is associated with linear deposition of immunoglobulin and complement on the alveolar surface. Clin Microbiol Infect. 2010 Jun;16(6):593-9.
8. Thunga G, John J, Sam KG, Khera K, Khan S, Pandey S et al. Role of hi¬gh-dose corticosteroid for the treatment of leptospirosis-induced pulmonary hemorrhage. J Clin Pharmacol. 2012 Jan;52(1):114-6.
9. Luks AM, Lakshminarayanan S, Hirschmann JV. Leptospirosis presenting as diffuse alveolar hemorrhage: case report and literature review. Chest. 2003 Feb;123(2):639-43.
10. Kularatne SA, Budagoda BD, de Alwis VK, Wickramasinghe WM, Banda¬ra JM, Pathirage LP, et al. High efficacy of bolus methylprednisolone in se¬vere leptospirosis: a descriptive study in Sri Lanka. Postgrad Med J. 2011 Jan;87(1023):13-7.
How to Cite
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to firstname.lastname@example.org
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to email@example.com