Case Report: Pulmonary Leptospirosis Misdiagnosed as COVID-19

Abstract

We report the case of an 83-year-old woman with acute, febrile respiratory failure resulting from interstitial pneumonia that required high-flow oxygen therapy. This clinical picture, associated with the ongoing epidemiological situation, initially guided us toward a diagnosis of COVID-19. Based on SARS-CoV-2 reverse transcription–polymerase chain reaction negativity and the absence of anti-SARS-CoV-2 antibodies, a search for a differential diagnosis was conducted that led us to conclude a diagnosis of severe pulmonary leptospirosis This case highlights the need to engage in early discussions about differential diagnoses, including neglected tropical and subtropical diseases, during the COVID-19 era.

Infezioni in Medicina

“…Gardening, although it may not have a high association with leptospirosis, in some cases can be the only background, as was reported in one case [14,37]. The remaining two cases, working as a farmer and living in a farmers' village were the only antecedents that helped to reach the diagnosis of leptospirosis; performing different farming activities have already been reported to be significant risk factors for leptospirosis [18,22,38,39]. Orthohantaviruses are negative-stranded RNA viruses classified into two major groups which cause hemorrhagic fever with renal syndrome (HFRS) or hantavirus cardiopulmonary syndrome [40].…”

“…Contact with rodents or their excreta is the leading risk factor for acquiring the disease; however, other environmental, occupational, and recreational activities may also generate a risk for human infection [36]. In only one of the cases, contact with rodents was reported [22]. Gardening, although it may not have a high association with leptospirosis, in some cases can be the only background, as was reported in one case [14,37].…”

“…All of them developed febrile respiratory illness, which may have led to misdiagnosis; however, in one case [14], jaundice was also developed, which helped to diagnose leptospirosis. In three cases, laboratory parameters included at least two of the following: kidney failure features, liver damage features, and thrombocytopenia, which can also indicate leptospirosis [14,18,22,35]. Contact with rodents or their excreta is the leading risk factor for acquiring the disease; however, other environmental, occupational, and recreational activities may also generate a risk for human infection [36].…”

“…The patient has also reported contact with rats present in the garden. Although the patient showed clinical improvement, amoxicillin was prescribed, and steroid therapy continued showing continuous improvement [22].…”

A Confusing case, leptospirosis during COVID-19 pandemic: A case report

“…since march 11, 2020 world health organization (WHO) reported a worldwide pandemic occurring by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) (1,2). COVID-19 infections symptoms includes a variation of fever, cough, dyspnea, headache, myalgia and abdominal pain (3).Since then, there were reports of coinfections or misdiagnoses of covid-19 with other infections which have the same clinical or paraclinical symptoms (4,5). Leptospirosis is a common infection in Southeast Asia and is one of those infections which can have the same symptoms as COVID-19 including cough and myalgia (6).…”