Leptospirosis presenting as ascending progressive leg weakness and complicating with acute pancreatitis

Abstract

Leptospirosis is a spirochetal bacterial infection of great public health importance. It has a broad spectrum of clinical manifestations which goes from subclinical infection and self-limited anicteric febrile illness (80-90% of all cases) to icteric leptospiropirosis known as Weil's disease. This is a severe disease characterized by hemorrhage, acute renal failure and jaundice. It is uncommon for leptospirosis to present itself as a primary neurological disease. Additionally, acute pancreatitis is an unusual gastrointestinal manifestation. We report a case of leptospirosis presenting as ascending progressive leg weakness and complicating with acute pancreatitis in an adult patient treated at Hospital Universitário, Universidade Federal de Santa Catarina. The diagnosis was confirmed through ELISA-IgM antibody testing positive for leptospirosis. After antibiotic therapy and support treatment for a few weeks, total resolution of severe manifestations was achieved. Rare and unusual presentations of leptospirosis should be kept in mind in relevant epidemiological scenario.

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.…”

Cervical—pharyngeal—brachial Variant of Guillain—Barré Syndrome: A Sequel of Leptospirosis

“…Bal et al 6 described classical variant of GBS postleptospirosis infection. Silva et al 7 described a case of ascending progressive leg weakness with acute pancreatitis postleptospirosis. Our case presented as cervical-pharyngeal-brachial variant of GBS postleptospira infection.…”

Лептоспіроз: Аспекти Ураження Нервової Системи

“…Механізм, за яким лептоспіри викликають СГБ, недостатньо вивчений, ймовірно, через те, що СГБ відмічають рідко. Цілком можливо, що він може виникати внаслідок імунних механізмів [22]. R.W.…”

“…Хвороба характеризується арефлекторним паралічем з легким сенсорним залученням та наявністю білково-клітинної дисоціації в СМР. Проте у пацієнтів із СГБ може бути нормальний рівень білка у лікворі (приблизно в 1/3 пацієнтів), якщо тестування проводили раніше, ніж через 1 тиж після появи симптомів [22].…”