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Acute painless pancreatitis as an unusual presentation of leptospirosis in a low-incidence country.
BMJ Case Rep. 2020 Aug 24; 13(8)BC

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.

Authors+Show Affiliations

Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel amischatt@gmail.com. Laniado Hospital, Sanz Medical Centre, Netanya, Israel.Laniado Hospital, Sanz Medical Centre, Netanya, Israel.Laniado Hospital, Sanz Medical Centre, Netanya, Israel.Laniado Hospital, Sanz Medical Centre, Netanya, Israel.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32843404

Citation

Schattner, Ami, et al. "Acute Painless Pancreatitis as an Unusual Presentation of Leptospirosis in a Low-incidence Country." BMJ Case Reports, vol. 13, no. 8, 2020.
Schattner A, Dubin I, Glick Y, et al. Acute painless pancreatitis as an unusual presentation of leptospirosis in a low-incidence country. BMJ Case Rep. 2020;13(8).
Schattner, A., Dubin, I., Glick, Y., & Nissim, E. (2020). Acute painless pancreatitis as an unusual presentation of leptospirosis in a low-incidence country. BMJ Case Reports, 13(8). https://doi.org/10.1136/bcr-2020-234988
Schattner A, et al. Acute Painless Pancreatitis as an Unusual Presentation of Leptospirosis in a Low-incidence Country. BMJ Case Rep. 2020 Aug 24;13(8) PubMed PMID: 32843404.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute painless pancreatitis as an unusual presentation of leptospirosis in a low-incidence country. AU - Schattner,Ami, AU - Dubin,Ina, AU - Glick,Yair, AU - Nissim,Elizabeth, Y1 - 2020/08/24/ PY - 2022/08/24/pmc-release PY - 2020/8/27/entrez PY - 2020/8/28/pubmed PY - 2021/2/16/medline KW - acute renal failure KW - general practice / family medicine KW - infection (gastroenterology) KW - infectious diseases KW - pancreatitis JF - BMJ case reports JO - BMJ Case Rep VL - 13 IS - 8 N2 - 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. SN - 1757-790X UR - https://www.unboundmedicine.com/medline/citation/32843404/Acute_painless_pancreatitis_as_an_unusual_presentation_of_leptospirosis_in_a_low_incidence_country_ L2 - https://casereports.bmj.com/lookup/pmidlookup?view=long&pmid=32843404 DB - PRIME DP - Unbound Medicine ER -