AUTHOR=Shi Yunzhen , Guo Wanru , Hu Ming , Wang Yuxuan , Li Jingnan , Hu Wenjuan , Li Xiaomeng , Xu Kaijin 

TITLE=A case of severe leptospirosis with Jarisch–Herxheimer reaction presenting as respiratory failure

JOURNAL=Frontiers in Public Health

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1125306

DOI=10.3389/fpubh.2023.1125306

ISSN=2296-2565

ABSTRACT=<sec><title>Background</title><p>Leptospirosis is a widespread zoonotic disease caused by pathogenic <italic>Leptospira</italic> spp. The treatment of penicillin or tetracycline can cause a Jarisch–Herxheimer reaction (JHR), which can lead to acute respiratory distress syndrome (ARDS) and multi-organ failure in severe cases. The overall course of evolution and imaging features of a JHR exacerbation of leptospirosis have rarely been reported.</p></sec><sec><title>Case presentation</title><p>We present a case of leptospirosis complicated by pulmonary alveolar hemorrhage and a Jarisch-Herxheimer reaction (JHR) that required respiratory and vasopressor support. This case demonstrates a well-defined course of evolution of JHR and the imaging features.</p></sec><sec><title>Conclusions</title><p>Leptospirosis is easily misdiagnosed in some sporadic areas, and JHR complicates its management. Early diagnosis and appropriate treatment can reduce the mortality of severe leptospirosis with JHR.</p></sec>