Isolated ARDS in a leptospirosis positive patient: An unusual sole presentation of anicteric leptospirosis

Leptospirosis is generally a self-limiting zoonotic disease, although severe variants such as Weil’s disease often warrant organ support in the Intensive Care Unit (ICU). In most endemic regions, the disease may be suspected from its associated clinical features. We present a case of a young male with a history of swimming in a freshwater lake who then presented to us with predominantly pulmonary symptoms. None of the defining clinical features of leptospirosis was present. He was intubated and ventilated for seven days in our ICU for hypoxemia and pulmonary haemorrhage. During this time, he had repeated bouts of pulmonary haemorrhage and hypoxemia while all of the organ systems typically affected by leptospirosis remained normal (platelet count, renal and liver function). Where a possible clinical exposure has occurred, leptospirosis should be considered in cases of pulmonary haemorrhage and Acute Respiratory distress syndrome (ARDS) even if classic clinical features are absent, especially in endemic regions.