Acute painless pancreatitis as an unusual presentation of leptospirosis in a low-incidence country

Abstract

A healthy, urban-dwelling man presented with lassitude, jaundice without increased liver enzymes or obstructive features on imaging, brief acute kidney injury, leucocytosis with near-normal C reactive protein and markedly increased serum amylase and lipase. Leptospirosis was not considered for 10 days because of the low incidence of the disease in the country, absent animal contact and physicians’ low index of suspicion. Presentation without fever and without the commonly associated abdominal pain, myalgia, headache, thrombocytopaenia or elevated serum creatine kinase added to the diagnostic challenge. Once an infectious cause of acute pancreatitis was contemplated, leptospirosis was immediately sought and diagnosed by PCR of urine and microscopic agglutination test, and he fully recovered on ceftriaxone. Physicians in countries with a low incidence of leptospirosis should be more aware of the possibility of the disease even when several key features such as fever or pain are missing and the patient has a rare infectious acute pancreatitis.

Clinical characteristics and outcomes of patients with leptospirosis complicated with acute pancreatitis: a systematic review

“…Other clinical signs were abdominal tenderness (n = 15, 18.9%), conjunctival suffusion (n = 13, 16.4%), tachypnea (n = 10, 12.6%), and basal crepitation (n = 9, 11.3%) ( Table 1 ). 3 , 6 , 8 , 11 – 15 , 17 , 19 , 21 – 47 …”

“…A judicious fluid regimen was used in six (7.5%) patients, and a liberal fluid regimen was used in one (1.2%) patient (Table 4). 3,6,8,[11][12][13][14][15]17,19, Among all 79 patients, intravenous (IV) penicillin G (n ¼ 22, 27.8%), IV ceftriaxone (n ¼ 18, 22.7%), and doxycycline (n ¼ 9, 11.3%) were the most commonly used drugs. Other commonly used drugs were IV hydrocortisone (n ¼ 8, 10.1%), IV meropenem (n ¼ 3, 3.7%), IV imipenem (n ¼ 3, 3.7%), and IV ampicillin sulbactam (n ¼ 3, 3.7%).…”

“…The screening process resulted in the inclusion of 35 1). 3,6,8,[11][12][13][14][15]17,19, Biochemical and electrocardiographic findings 2). 3,6,8,[11][12][13][14][15]17,19, Radiological findings The most common findings in CECT were a large bulky pancreas (n ¼ 5, 6.3%), peripancreatic fat stranding (n ¼ 5, 6.3%), an edematous pancreatitis (n ¼ 5, 6.3%), hepatosplenomegaly (n ¼ 4, 5.0%), and PPNC (n ¼ 4, 5.0%).…”

“…3,6,8,[11][12][13][14][15]17,19, Biochemical and electrocardiographic findings 2). 3,6,8,[11][12][13][14][15]17,19, Radiological findings The most common findings in CECT were a large bulky pancreas (n ¼ 5, 6.3%), peripancreatic fat stranding (n ¼ 5, 6.3%), an edematous pancreatitis (n ¼ 5, 6.3%), hepatosplenomegaly (n ¼ 4, 5.0%), and PPNC (n ¼ 4, 5.0%). The remaining findings were ascites (n ¼ 3, 3.7%), bilateral pleural effusion (n ¼ 2, 2.5%), and isolated hepatomegaly (n ¼ 1, 1.2%).…”

“…18 It should be noted that clinical manifestations are not reliable because both AP and leptospirosis have common symptoms and signs. 19 Early identification and treatment, including both operative and nonoperative measures, are important to minimize complications. 20 A synopsis of existing evidence on leptospirosis complicated by AP is needed.…”