Unusual presentation of urban leptospirosis complicated by a septic shock

Abstract

Leptospirosis, an infectious zoonosis, is common to tropical areas. The clinical presentation varies from flu-like symptoms to a serious presentation called Weil’s syndrome. Fever and conjunctival suffusion are present in the majority of patients. This case report describes a resident of New York City who presented initially with gastroenteritis symptoms without fever or conjunctival suffusion to develop septic shock before being diagnosed with leptospirosis.

Leptospirosis as an unusual culprit of acute pancreatitis and portal vein thrombosis in a New Yorker

“…According to NYC.gov, an average of 3 cases of leptospirosis are diagnosed in New York City each year, but the case rate has been increasing during the last decade with an average of 5.7 yearly cases reported over the past 3 years . One case report of urban leptospirosis in New York City showed a case of septic shock in a patient who had an infestation of rats at their residence . Other cases of leptospirosis associated with pancreatitis have been published in literature localized to Central Europe and Sri Lanka, but no such cases in North America have ever been described .…”

“…25 One case report of urban leptospirosis in New York City showed a case of septic shock in a patient who had an infestation of rats at their residence. 26 Other cases of leptospirosis associated with pancreatitis have been published in literature localized to Central Europe and Sri Lanka, but no such cases in North America have ever been described. 27,28 Patients typically present with jaundice, renal failure, and bleeding.…”

Going Micro in Leptospirosis Kidney Disease

“…Severe leptospirosis is complicated by sepsis and septic shock [ 29 , 30 ]. In the early phase, leptospirosis is related to an overwhelming activation of inflammasomes and proinflammatory cytokines, causing kidney inflammation and subsequent damage.…”

“…Sepsis in leptospirosis, with or without shock, can occur as an unusual presentation, primarily in urban areas [ 29 ]. Similar to general sepsis management, the treatment of sepsis in leptospirosis is based on rapid administration of the correct antibiotic and the best supportive care [ 112 ].…”

Acute Kidney Injury and Acute Liver Failure in Leptospira Infection and Weil’s Syndrome

“…Other less specific symptoms, which are reported less frequently, include muscle aches, headaches, colds, and mucosal hemorrhage (21) (Figure 1D and 1E), including influenza (22), pancreatitis (23), and gastrointestinal symptoms, with vomiting and diarrhea, and fatal septic shock (21). There are reports of neurological symptoms such as aseptic meningitis, reversible posterior encephalopathy (24), and focalization symptoms due to intracerebral thrombosis (25) (Figure 1D and 1E). The simultaneous development of hepatic and renal failure, together with hemorrhagic complications (highly severe when they occur in the lungs), is called Weil's syndrome (26,27), and represents the severe phase of leptospirosis.…”