Prone Ventilation in Successful Treatment of Severe Leptospirosis with Alveolar Hemorrhage Syndrome and ARDS

Leptospirosis is one of the most spread zoonotic infections in large cities. It's characterized by fever, jaundice, AKI, Acute liver failure, bleeding especially from lungs as known as severe pulmonary hemorrhage with acute respiratory distress syndrome (ARDS), that is one of the most severe and fatal complication of leptospirosis. In this report, we present case of severe leptospirosis. 48-year-old man was admitted to the emergency department Patients clinical status has dramatically worsened in short period of time before hospitalization he had following symptoms: headache, myalgia, arthralgia, fever, shortness of breath and hemoptysis. He was transferred to the intensive care unit and intubated. Almost 700ml of fresh blood was suctioned from tracheobronchial tree. Chest computer tomography revealed bilateral infiltrates, Pao2/Fio2 ratio was <100mmHg that corresponds to severe ARDS. Despite Mechanical ventilation hypoxemia and hypercapnia worsened we started prone ventilation with high positive end-expiratory pressure (PEEP). Other treatments included: Steroids (pulse therapy of methylprednisolone), antibiotics, (broad spectrum penicillin) plasmapheresis and hemodialysis. After the treatment patient had been restored to health and discharged at day 25