Leptospirosis Presenting as Diffuse Alveolar Hemorrhage

Diffuse alveolar hemorrhage (DAH) syndrome has a mortality rate of 30 to 60%. A 15-year-old male patient presented with seven-day abdominal pain, vomiting, non-dysenteric diarrhea, conjunctival injection, and fever. Chest radiography revealed bilateral interstitial infiltrates predominating in the lower left lobe. The patient’s condition worsened within hours, development massive hemoptysis, acute respiratory distress (ARDS), arterial hypotension, hematocrit decline requiring mechanical ventilation. chest computed tomography (CT) showed ground-glass opacities consolidation areas lobes, diffuse tree-in-bud opacities, centrilobular nodules. bronchoscopy was conducted without endoluminal lesions bronchoalveolar lavage (BAL) consistent hemorrhage. DAH diagnosed, received therapy intravenous methylprednisolone. outcome treatment successful after eight days Leptospirosis diagnosed by serology discharge. laboratory findings were normal, CT scan resolution infiltrates. Early recognition severe hemorrhagic pulmonary syndrome, which high rate, is crucial. Therefore, leptospirosis should be suspected as differential diagnosis every hemorrhage, ARDS manifestations, epidemiological factors.