Rare case of icterohaemorrhagic Leptospirosis with pulmonary involvement and review of the literature

Abstract

Introduction
Leptospirosis is a ubiquitous bacterial anthropozoonosis, highly endemic in hot, humid tropical regions. It is caused by a spirochete of the genus Leptospira, whose reservoir is animals. It is classically responsible for hepatatoencephritic disease associated with thrombocytopenia. Pulmonary forms, whether inaugural, isolated or complicating leptospirosis, are extremely serious and have a high mortality rate. Observation : However, we report the case of a 49-year-old patient, a plumber by profession, who presented 10 days prior to admission with generalised febrile jaundice associated with a flu-like syndrome and disturbances of consciousness. The patient presented clinically with flaming orange jaundice with purpuric lesions and bilateral conjunctival injection, and biologically with thrombocytopenia, hepatic cytolysis, cholestasis and renal failure. The symptoms were complicated by intra-alveolar haemorrhage, which required intensive care. The outcome was favourable and the diagnosis was subsequently confirmed by a microagglutination test identifying Leptospira icterohaemorrhagiae. Conclusion : In the absence of a Leptospira vaccine, treatment is based on individual protective measures, as well as raising awareness of leptospirosis, a zoonosis that is still poorly understood by health professionals in Morocco.