Methylprednisolone-Responsive Leptospiral Acute Pulmonary Syndrome: A Case Report

Authors

  • Iman D. Johan-Arief, Monash University, Selangor, Malaysia.
  • Shen H. Lee Monash University, Selangor, Malaysia.
  • Xin Y. Er Monash University, Selangor, Malaysia.
  • Ganesh Kasinathan Segamat Hospital, Segamat, Malaysia.
  • Naganathan Pillai Segamat

DOI:

https://doi.org/10.5195/ijms.2015.138

Keywords:

Fever, Hemoptysis, Leptospirosis, Methylprednisolone, Agglutination, Tests

Abstract

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

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Author Biography

Iman D. Johan-Arief,, Monash University, Selangor, Malaysia.

Iman Daniel is currently a fi¬nal-year medical student at Monash University Malaysia. He has a keen interest in pathology and was offered the Pathology Update 2015 Conference scholarship to attend the conference in Melbourne, Australia.

References

1. Ko AI, Goarant C, Picardeau M. Leptospira: the dawn of the molecular genetics era for an emerging zoonotic pathogen. Nat Rev Microbiol. 2009 Oct;7(10):736-47.
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.

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Published

2015-12-04

How to Cite

D. Johan-Arief, I., H. Lee, S., Y. Er, X., Kasinathan, G., & Pillai, N. (2015). Methylprednisolone-Responsive Leptospiral Acute Pulmonary Syndrome: A Case Report. International Journal of Medical Students, 3(3), 159–162. https://doi.org/10.5195/ijms.2015.138

Issue

Vol. 3 No. 3 (2015)

Section

Case Report

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