Leptospirosis pulmonary haemorrhage: a diagnostic challenge

Leptospirosis is a re-emerging zoonosis with worldwide distribution. Antibiotic treatment is available, but leptospirosis is rarely suspected due to the non-specific clinical presentation, and is also underreported due to the difficulty in confirming the diagnosis. The syndrome of leptospirosis pulmonary haemorrhage is increasingly described; it is severe and can present without the classical manifestations of Weil's disease. We discuss two cases of leptospirosis with pulmonary haemorrhage; both our patients experienced a dramatic deterioration hours after their admission, and required emergency intubation and intensive therapy unit support. Massive haemoptysis is a life threatening complication of leptospirosis, even outside tropical areas.