A rapid turn for the worse: Steroid-responsive pulmonary haemorrhage in leptospirosis

A 43-year old man presented with fever and cough and was initially treated for community-acquired pneumonia. Within 24 h, he deteriorated and was admitted with type 1 respiratory failure. A recent history of exposure to waterlogged fields, along with progressive decline in haemoglobin, platelet counts and deranged liver function tests, raised suspicion for leptospirosis, later confirmed by positive IgM serology. With progressive clinical and radiological worsening, severe pulmonary haemorrhagic syndrome was considered. He was managed with oxygen, noninvasive ventilation (NIV), ceftriaxone, doxycycline, cotrimoxazole, and pulse methylprednisolone. He showed significant improvement and was successfully weaned off NIV and oxygen. This case highlights the importance of early recognition and timely initiation of steroid therapy in severe leptospiral pulmonary involvement.