S1779 A Peculiar Case of Jaundice and Renal Failure After Hurricane Ida

Abstract

Introduction: Leptospirosis is a zoonotic disease seen in tropical and temperate regions, with roughly 1.03 million cases worldwide and 58,900 deaths annually. Humans are infected when exposed to the tissue or urine of colonized rodents, cattle, swine, dogs, or sheep. The symptoms are nonspecific but include fever, myalgia, and rigors. Laboratory findings in severe cases include hyponatremia, elevated hepatic enzymes, renal failure, and thrombocytopenia. Transaminases are typically mildly elevated, but total bilirubin can increase to as high as 80 mg/dL. The associated jaundice is thought to be due to hepatocellular necrosis, intrahepatic cholestasis, and absorption of tissue hemorrhage. In severe cases of jaundice and renal failure, “Weil's Disease” is diagnosed. Case Description/Methods: Hurricane Ida produced record rainfall in the northeastern US over an 18 hour period. Five days following the storm, a 52 year old male with no significant past medical history, presented to our ER complaining of fever, night sweats, chills, fatigue, and generalized weakness. For work, he had been tasked to clear pools of stagnant water from normally dry areas of urban parks. On presentation, his blood pressure was 136/68 mmHg, heart rate 159 bpm, temperature 36.4 degrees C, and oxygen saturation of 95% on room air. His exam was notable for scleral icterus, jaundice, and tachycardia. The abdomen was soft, non-tender and non-distended, and without hepatomegaly. Laboratory values are given in the Table. The patient’s renal failure subsequently worsened with BUN/creatinine reaching 114/7.48 mg/dL. Abdominal ultrasound and MRCP demonstrated no abnormalities. On day 4 urine DNA for Leptospira was positive, though serum Leptospira PCR was negative. He was started on doxycycline and ceftriaxone with improvement in his symptoms, jaundice and renal failure. Discussion: Leptospira is endemic in mostly southern and Pacific coastal areas of the US, as well as Hawaii. In developed countries, leptospirosis is commonly seen after heavy rainfall and floods. Over the past 5 years, locally acquired cases of leptospirosis have surpassed travel associated infection in our local jurisdiction. Climate studies have pointed to a positive correlation between cases of leptospirosis and significant changes in climate and associated flooding. Given the potential severity of leptospirosis, community education to avoid stagnant water and barrier coverage in emerging Leptospirosis hotspots could be beneficial in the prevention of disease. Table 1. - Relevant Labs from Admission Hemoglobin 14.3 g/dL Platelets 68,000 u/L MCV 84 fL ESR 58 ml/Hr BUN / Cr 54 mg/dL / 2.9 mg/dL Sodium 129 mmol/L Total Bilirubin 6.7 mg/dL Direct Bilirubin 5.08 mg/dl ALT 78 unit/L AST 191 unit/L Alkaline Phosphatase 102 unit/L CPK 3,600 unit/L Lipase 2.3 unit/L Hepatitis A,B,C serology evidence of prior HBV vaccination Ds-DNA within normal limits Immunoglobin A,G,E,M within normal limits