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Key Clinical Message  The traditional concept of immediate antibiotic treatment in suspected leptospirosis seems to be especially important for patients up to day 4 of clinical illness. As immune mechanisms probably play a crucial role in advanced leptospirosis with presumed pulmonary hemorrhages, patients might benefit from corticosteroids or other immunosuppressive agents beside antibiotics.

Severe Leptospira interrogans serovar Icterohaemorrhagiae infection with hepato‐renal‐pulmonary involvement treated with corticosteroids