Primary neuroleptospirosis complicating cerebral venous sinus thrombosis: a case report

Abstract

Leptospirosis, caused by pathogenic spirochetes of the genus Leptospira, presents as a biphasic illness consisting of an initial leptospiraemic phase followed by an immune phase. Nevertheless, leptospirosis remains undiagnosed on numerous occasions, particularly when it presents with neurological complications, due to its infrequent and atypical nature. Primary neuroleptospirosis complicated by cerebral venous sinus thrombosis emerges as an infrequent, and life-threatening complication, associated with a high mortality risk.We report a 55-year-old man presented with fever and headache of two days duration, which progressed into clouding of consciousness on the third day. Clinical examination revealed conjunctival suffusion, Glasgow coma scale (GCS) of 11/15, disorientation, and meningism. The diagnosis was confirmed by detecting Leptospira DNA in cerebrospinal fluid through real-time PCR, and a subsequent magnetic resonance venogram revealed sigmoid and transverse sinuses thrombosis, which was performed due to the patient’s persistent occipital headache.This case report underscores the significance of recognizing rare manifestations of common tropical diseases in endemic areas and the importance of thorough patient history in diagnosis, as in this patient where leptospirosis was suspected due to recent risk exposure.