A case of leptospirosis with rare atypical presentation as paraparesis

Abstract

We report a patient presenting with paraparesis with polyneuropathy who later developed haemorrhagic manifestations and multi-organ involvement and seizures. Diagnostic work-up confirmed the diagnosis of leptospi-rosis. The presentation of paraparesis in combination with Weil's syndrome is rare. However, the development of haemorrhagic manifestations and seizures after initial presentation of paraparesis has not been reported previously. A high index of suspicion is necessary for initiating appropriate diagnostic work-up as it is a treatable condition.

Leptospirosis‐induced acute acquired inflammatory neuropathy

“…In their paper "Neurological aspects of leptospirosis" in 1959, R.W.Ross Russel et al described the case of an ascending symmetrical paralysis resembling an acute infective polyradiculitis. 3 A few other reports have since been published, [4][5][6][7] such as those of Kobawaka Gamage and Fernando et al, 6 where they describe a demyelinating variant of Guillain-Barre syndrome (GBS) that improved considerably with plasma exchange. 6 We present a somewhat similar case of a 30-year-old male who developed flaccid tetraparesis and multiple cranial neuropathies on the fourteenth day of admission to the ICU for fever and multi-organ failure.…”

“…In their paper “ Neurological aspects of leptospirosis ” in 1959, R.W.Ross Russel et al described the case of an ascending symmetrical paralysis resembling an acute infective polyradiculitis 3 . A few other reports have since been published, 4‐7 such as those of Kobawaka Gamage and Fernando et al, 6 where they describe a demyelinating variant of Guillain‐Barre syndrome (GBS) that improved considerably with plasma exchange 6 …”