title: Successful treatment of pulmonary hemorrhage associated with leptospirosis and scrub typhus coinfection by early plasma exchange.
abstract: Leptospirosis and scrub typhus coinfections have been reported in up to 41% of agricultural workers with acute leptospirosis in Thailand, but only sporadically in Taiwan. Because of the nonspecific clinical presentations, it is difficult to differentiate patients with coinfections from leptospirosis alone. However, failure to identify coinfection may lead to mortality if inappropriate antibiotics are used. We report a 31-year-old man coinfected with leptospirosis and scrub typhus, which manifested as diffuse alveolar hemorrhage and acute renal failure mimicking pulmonary-renal syndrome. The patient was treated by early plasma exchange and a 7-day course of moxifloxacin therapy. Both pulmonary hemorrhage and hypoxemia resolved substantially on the 4th day of hospitalization. He had a complete recovery from the disease after 6 weeks of hospitalization.
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Yun-Sung
authors.initials: YS
authors.lastname: Chen
authors.forename: Shih-Lung
authors.initials: SL
authors.lastname: Cheng
authors.forename: Hao-Chien
authors.initials: HC
authors.lastname: Wang
authors.forename: Pan-Chyr
authors.initials: PC
authors.lastname: Yang
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007922:Leptospirosis / Q000150:complications*; D008171:Lung Diseases / Q000209:etiology / Q000628:therapy*; D008297:Male; D010951:Plasma Exchange / Q000379:methods*; D012612:Scrub Typhus / Q000150:complications*
chemical_list: D000900:Anti-Bacterial Agents