Recreational ‘mud fever’: Leptospira interrogans induced diffuse alveolar hemorrhage and severe acute respiratory distress syndrome in a U.S. Navy seaman following ‘mud-run’ in Hawaii

Schmalzle, Sarah A; Tabatabai, Ali; Mazzeffi, Michael; Matta, Ann; Hollis, Allison; Zubrow, Marc; Rajagopal, Keshava; Thom, Kerri; Scalea, Thomas

We have presented this case to raise awareness of the need for consideration of leptospirosis in the differential diagnosis for any patient who presents with pulmonary hemorrhage or frank DAH, in addition to other vascular and infectious etiologies more commonly seen in the United States. The importance of obtaining epidemiological data on travel and exposures cannot be understated. Anyone engaging in recreational water-based activities in areas endemic for Leptospira spp. should be made aware of the potential risks. Further research on the role of chemoprophylaxis is needed, especially as the cases of leptospirosis become more common in traditionally non-endemic areas due to climate change. Additionally, this case highlights the potential benefits of ECMO in LPHS and of streamlining transition of care from community hospitals to tertiary care centers for patients requiring advanced support strategies such as ECMO.