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Leptospirosis Presenting with Rapidly Progressing Acute Renal Failure and Conjugated Hyperbilirubinemia: A Case Report.
Am J Case Rep. 2016 Aug 10; 17:567-9.AJ

Abstract

BACKGROUND

Unexplained renal insufficiency combined with hepatic failure is a common problem encountered by clinicians. As with many disease processes involving multi-organ systems, reversible causes are usually not readily identifiable, and for many patients their health deteriorates rapidly. We present a rare cause of acute renal failure and hyperbilirubinemia occurring simultaneously, with leptospirosis presenting as Weil's disease. CASE REPORT A 53-year-old male presented to our clinic with complaints of anuria over the past two days. His symptoms started with dark urine, severe cramps in the thighs, and chills. The patient was a visitor to the United States from Guyana. Positive physical examination findings included mild tachycardia and hypotension, scleral icterus, and tenderness over abdomen, costovertebral angles, and thighs. The patient had a high white blood cell count, thrombocytopenia, renal/hepatic insufficiency, and an urinary tract infection (UTI). The patient was initially treated under the suspicion of acute kidney injury secondary to rhabdomyolysis and pyelonephritis. The patient continued to deteriorate with decreasing platelet counts, worsening renal function, hyperbilirubinemia, and respiratory distress, with no improvement with hemodialysis. Broad-spectrum antibiotics were administered, including doxycycline, due to a high suspicion of leptospirosis. The patient's condition drastically improved after initiation of doxycycline. On subsequent days, the patient's Leptospira antibody results were available, showing titers of more than 1:3200. Hemodialysis was discontinued as the patient started producing urine with improved kidney function.

CONCLUSIONS

As world travel becomes more economically feasible, we will continue to encounter foreign endemic diseases. Leptospirosis presenting as Weil's disease is a common cause of renal and hyperbilirubinemia in endemic areas. Often, as was the case for our patient where the time from presentation to acute respiratory distress syndrome (ARDS) was 72 hours, the diagnosis evolves over the course of several days. Antibody testing often takes time and delays in treatment can cause rapid clinical deterioration. In such cases, we recommend beginning empiric treatment before confirmation of laboratory tests.

Authors+Show Affiliations

Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, NY, USA.Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, NY, USA.Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, NY, USA.Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, NY, USA.Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, NY, USA.Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, NY, USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27506868

Citation

Pothuri, Pallavi, et al. "Leptospirosis Presenting With Rapidly Progressing Acute Renal Failure and Conjugated Hyperbilirubinemia: a Case Report." The American Journal of Case Reports, vol. 17, 2016, pp. 567-9.
Pothuri P, Ahuja K, Kumar V, et al. Leptospirosis Presenting with Rapidly Progressing Acute Renal Failure and Conjugated Hyperbilirubinemia: A Case Report. Am J Case Rep. 2016;17:567-9.
Pothuri, P., Ahuja, K., Kumar, V., Lal, S., Tumarinson, T., & Mahmood, K. (2016). Leptospirosis Presenting with Rapidly Progressing Acute Renal Failure and Conjugated Hyperbilirubinemia: A Case Report. The American Journal of Case Reports, 17, 567-9.
Pothuri P, et al. Leptospirosis Presenting With Rapidly Progressing Acute Renal Failure and Conjugated Hyperbilirubinemia: a Case Report. Am J Case Rep. 2016 Aug 10;17:567-9. PubMed PMID: 27506868.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Leptospirosis Presenting with Rapidly Progressing Acute Renal Failure and Conjugated Hyperbilirubinemia: A Case Report. AU - Pothuri,Pallavi, AU - Ahuja,Keerat, AU - Kumar,Viki, AU - Lal,Sham, AU - Tumarinson,Taisiya, AU - Mahmood,Khalid, Y1 - 2016/08/10/ PY - 2016/8/11/entrez PY - 2016/8/11/pubmed PY - 2017/2/15/medline SP - 567 EP - 9 JF - The American journal of case reports JO - Am J Case Rep VL - 17 N2 - BACKGROUND Unexplained renal insufficiency combined with hepatic failure is a common problem encountered by clinicians. As with many disease processes involving multi-organ systems, reversible causes are usually not readily identifiable, and for many patients their health deteriorates rapidly. We present a rare cause of acute renal failure and hyperbilirubinemia occurring simultaneously, with leptospirosis presenting as Weil's disease. CASE REPORT A 53-year-old male presented to our clinic with complaints of anuria over the past two days. His symptoms started with dark urine, severe cramps in the thighs, and chills. The patient was a visitor to the United States from Guyana. Positive physical examination findings included mild tachycardia and hypotension, scleral icterus, and tenderness over abdomen, costovertebral angles, and thighs. The patient had a high white blood cell count, thrombocytopenia, renal/hepatic insufficiency, and an urinary tract infection (UTI). The patient was initially treated under the suspicion of acute kidney injury secondary to rhabdomyolysis and pyelonephritis. The patient continued to deteriorate with decreasing platelet counts, worsening renal function, hyperbilirubinemia, and respiratory distress, with no improvement with hemodialysis. Broad-spectrum antibiotics were administered, including doxycycline, due to a high suspicion of leptospirosis. The patient's condition drastically improved after initiation of doxycycline. On subsequent days, the patient's Leptospira antibody results were available, showing titers of more than 1:3200. Hemodialysis was discontinued as the patient started producing urine with improved kidney function. CONCLUSIONS As world travel becomes more economically feasible, we will continue to encounter foreign endemic diseases. Leptospirosis presenting as Weil's disease is a common cause of renal and hyperbilirubinemia in endemic areas. Often, as was the case for our patient where the time from presentation to acute respiratory distress syndrome (ARDS) was 72 hours, the diagnosis evolves over the course of several days. Antibody testing often takes time and delays in treatment can cause rapid clinical deterioration. In such cases, we recommend beginning empiric treatment before confirmation of laboratory tests. SN - 1941-5923 UR - https://www.unboundmedicine.com/medline/citation/27506868/Leptospirosis_Presenting_with_Rapidly_Progressing_Acute_Renal_Failure_and_Conjugated_Hyperbilirubinemia:_A_Case_Report_ L2 - https://www.amjcaserep.com/download/index/idArt/897741 DB - PRIME DP - Unbound Medicine ER -