1304 The Great Mimicker: Leptospirosis

Abstract

INTRODUCTION: Leptospirosis is the most prevalent zoonotic disease with higher incidence in the tropical regions. Humans are infected after direct contact with urine of an infected animal or environmental exposure. Most infections are asymptomatic and self-limited while a severe life-threatening infection, known as Weil's disease, occurs in about 10% of patients. Among those with severe disease, hepatitis, acute kidney injury, myocarditis, and rarely, acute pancreatitis can develop. We herein report a case of an acute pancreatitis as an uncommon presentation of severe leptospirosis. CASE DESCRIPTION/METHODS: 71-year-old male patient with past medical history of hypertension, diabetes mellitus, presented with complaints of abdominal pain, myalgia, nausea as well as vomiting for seven days prior to admission. Patient has not been able to tolerate food due to nausea and severe diffuse abdominal pain. Initial physical examination was remarkable for dry oral mucosa and jaundice. Laboratory evaluation demonstrated microcytic anemia with Hgb 9.4 g/dL, WBCs in 9.7 × 10-3/ul with neutrophil predominance, and acute thrombocytopenia. A complete metabolic panel showed a severe direct hyperbilirubinemia with normal liver enzymes and an increased creatine, 1.5 times baseline. Lipase levels were three times upper limit that along with presenting symptoms suggested an acute pancreatitis. Further examination with an abdominal sonogram revealed a diseased acalculus gallbladder with a positive Murphy sign and no obstruction of the biliary tree. Initial clinical diagnosis of severe acute pancreatitis was made, however, findings of non-obstructive jaundice along acute renal failure raised the suspicion of Weil's disease. Acute medical care included intravenous ceftriaxone with adequate clinical response. During admission Leptospira IgG titers were positive with specificity of 100%. Following treatment with ceftriaxone the patient was uneventfully discharged home to complete oral doxycycline therapy for a total of seven days. DISCUSSION: Leptospirosis in Puerto Rico accounts for approximately 50% of all the cases reported in the United States. It is of foremost importance to be aware of the diverse clinical manifestations of Weil's disease, often, confused with a viral illness. Unusual etiologies can lead to common complaints in this case an acute pancreatitis; therefore, early identification and acute care management of infectious diseases can positively influence patient's outcome.