Bilateral patchy GGO

Non-lobar and peripheral distribution

Normal range of heart size
 

High resolution CT (admission)

Centrilobular GGO

Centrilobular nodules

Smooth interlobular septal thickening
 

Chest radiograph (#0 ~ #2)

Rapid progression of pulmonary infiltration and confluent consolidation

Clinical Findings

Laboratory findings

 Azotemia, thrombocytopenia, hyperbilirubinemia

 Antibody

 Leptospiral antibody; positive (1: 1280)

 Hantavirus, rickettsia, antimycoplasma, legionella, CMV, parainfluenza, PCP; all negative
 

Bronchoscopy

 Diffuse hemorrhage from bronchial tree

Brief Discussions
Leptospira interrogans - Leptospira icterohaemorrhagiae strain

Rodents and domestic animals - Direct contact / indirect (urine)

Involved organs - Liver, kidneys, muscles, CNS, lung (38-66%)

Pulmonary hemorrhage - Direct injury of capillary wall due to toxic substance
 

Radiologic Findings

Abnormalities on chest radiograph (64%)

Non-lobar and bilateral distribution (100%)

Mainly peripheral lung (50%)

Three patterns
   Multiple nodular opacities with or without focal areas of consolidation (57%)
   Large confluent areas of consolidation (16%)
   Diffuse, ill-defined areas of GGO (27%)

Small pleural effusion (19%), cardiomegaly (27%)


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