AN ATYPICAL CASE OF ATYPICAL PNEUMONIA

A 23-year-old man, previously fit and well, presented with an atypical pneumonia, associated with microangiopathic anaemia, thrombocytopenia , rhabdomyolysis and renal impairment. Despite administration of intra venous fluids and antibiotics, his condition rapidly deteriorated, and the possibility of an aggressive connective tissue disorder was raise d. Thus he was treated with high-dose oral steroids and plasma exchang e until autoantibodies were shown to be negative. At this stage it tra nspired that the patient had swallowed water from a stream three weeks earlier, and leptospira antibody titres were subsequently found to be elevated. Antibiotics were continued, acid after a protracted course he made a full recovery. Leptospirosis should be remembered as a rare cause of atypical pneumonia, particularly if there is associated hepat ic or renal impairment.