Role of steroids in a case of leptospirosis and dengue coinfection with acute respiratory distress syndrome

Abstract

Coinfection with leptospirosis and dengue complicated by acute respiratory distress syndrome (ARDS) is rare and potentially fatal. While steroids are generally contraindicated in dengue and their role in leptospirosis remains uncertain, management becomes challenging. This case highlights a situation where steroid therapy was beneficial. We describe a case of a 17-year-old male presenting with fever with chills, joint pain, abdominal pain and vomiting, hemoptysis and subsequent respiratory distress, diagnosed with concurrent leptospirosis and dengue. Despite the uncertain role of steroids in such a case of co-infections, methylprednisolone (MPS) was administered due to severe ARDS, yielding positive outcomes. This case underscores the complexity of managing coinfections and prompts reconsideration of treatment protocols. Literature review reveals conflicting evidence on steroid use in complicated cases as this one. The positive outcomes of administering steroids in this case highlight the need for further research to refine therapeutic approaches in managing complex coinfections. This case urges robust randomized controlled trials assessing corticosteroid efficacy in severe dengue shock syndrome and leptospirosis, given their potential to significantly improve patient outcomes.