Six cases of leptospirosis with pulmonary complications are reported. Three cases were accompanying an hepato-nephritis due to L. icterohaemorrhagiae. The first patient died with massive hemoptysis. The second, presenting a bilateral pneumopathy predominant on the left side, recovered after plasma exchange and hemofiltration. The third case concerned a pulmonary edema complicating a vascular refilling in a shock syndrome it simply recovered. The three other cases were observed in an anicteric leptospirosis: in two cases, L. Australis was responsible; in the last, L. icterohaemorrhagiae was involved. The first patient had a radiologic picture simulating miliary tuberculosis. The second had pulmonary edema complicating a vascular refilling in a shock syndrome. The last was an acute respiratory distress syndrome, treated with artificial ventilation with penicillin therapy and corticotherapy. All these 3 patients recovered. The diagnostic, physiopathologic and therapeutic problems of these pulmonary complications of leptospirosis are discussed. The lesional nature of the pulmonary edema is proved by the low pulmonary wedge pressures observed with the Swan-Ganz Catheter.

A 45 years old woman, hemodialysed since 1981, with an history of Staphylococcal septicemia in may 1983, is admitted in emergency room in may 1984 for massive gastro intestinal bleeding. After oesogastro fibroscopy suspecting duodenal ulcer, because continuous and recurrent bleeding, a laparotomy find only symptoms of portal hypertension (ascites, venous dilatation on abdominal oesophagus and stomach). The ligation of this venous dilatations stop temporarily the gastro intestinal bleeding. But recurrence of this bleeding conduct to a celiac angiography discovering a splenic aneurysm with arterio venous fistula. The surgical treatment of this aneurysm can stop the gastro intestinal bleeding. Histopathologic observation of this aneurysm can suspect an infectious origin.

In a patient with shock and hyperkalemia , a peritoneal dialysis, started to treat an hyperkalemia , showed the presence of chocolate-like pus in the peritoneal cavity, and confirmed the intraperitoneal rupture of an amoebic liver abscess . Peritoneal dialysis led to the correction of the metabolic disorders and of the shock and restored the diuresis, ensuring favourable conditions to surgical intervention. Surgical drainage of the abscesses and ornidazole treatment led to complete recovery.