Hemoptysis Associated with Leptospirosis Acquired in Hawaii, USA

Winchester, UK) collected 12 days after fever onset was positive. Antimicrobial drug treatment was changed to doxycycline and gentamicin. However, low-grade fever and low back pain developed 2 days after administration of gentamicin. The back pain was attributed to muscle pain and was almost completely relieved by 2-day treatment with a nonsteroidal antiinfl ammatory drug. Whole-body gallium scan and spine magnetic resonance imaging suggested osteomyelitis and epidural abscess over the third and fourth lumbar spines. The patient was treated with doxycycline for 6 weeks. A liver function test 2 weeks after admission showed values within reference limits. Cases of human brucellosis and animal sources of Brucella spp. have been reported from Algeria and Morocco (7–10). The most common laboratory fi ndings in patients with brucellosis are high C-reactive protein levels and anemia (3,4). The patient had high C-reactive protein levels but procalcitonin values within reference limits at admission. Hepatic involvement of brucellosis has been reported to range from 2% to 25% (3). The patient also had acute anicteric hepatitis, and serologic test results were negative for all hepatotropic viruses. The isolate from this patient exhibited high MICs for trimethoprim/ sulfamethoxazole, a fi nding rarely reported (5,6). The low MIC value of tigecycline suggests the potential role of this agent for the treatment of brucellosis. This report confi rms brucellosis in Taiwan. Brucellosis could become an emerging problem in this country, particularly given the frequency of travel between Taiwan and areas where brucellosis is endemic.