Leptospirosis presenting as atypical pneumonia, respiratory failure and pyogenic meningitis.

A 20-year-old man who looked after a pack of hounds was admitted with a short history of headache, fever, haemoptysis and muscle cramps. Investigations showed type I respiratory failure with diffuse pneumonitis, pyogenic meningitis and raised liver enzymes. Leptospirosis was suspected and treated with the appropriate antibiotics leading to a full recovery. The diagnosis was confirmed by a titre of I/2560 to Leptospira icterohaemorrhagiae. The case illustrates an unusual presentation of this infection and argues for early antibiotic treatment.