P4770 - Veiled in plain sight

Azha Fatima, MBBS¹, Fateen Shareef, MBBS², Aishwarya Alugani, MBBS³, Ratnachary P, MBBS, MD^3
1Kamineni Institute of Medical Sciences, Kansas City, MO; ²Deccan College of Medical Sciences, Kansas City, MO; ³Kamineni Institute of Medical Sciences, Hyderabad, Telangana, India

Introduction: Weil’s disease is a severe form of Leptospirosis causing fulminant hepato-renal-hemorrhagic syndrome. Incubation time may be 4-19 days. Only 10% of Leptospirosis cases develop Weil’s disease. It is an important differential in patients with concomitant hepatic and renal failure in endemic

Weil’s disease is a severe form of Leptospirosis causing fulminant hepato-renal-hemorrhagic syndrome. Incubation time may be 4-19 days. Only 10% of Leptospirosis cases develop Weil’s disease. It is an important differential in patients with concomitant hepatic and renal failure in endemic areas.

Case Description/Methods: A 53-year-old male farmer presented with remittent biphasic fever, dysuria, dyspnea, melena. Vitals on presentation were significant for respiratory rate 32/min, blood pressure 80/50mmHg. Examination revealed pallor, icterus, bilateral conjunctival suffusion, ecchymotic patches over legs, tachypnea, reduced breath sounds, crepitations, decreased tactile vocal fremitus, stony dull note on percussion, tenderness in right hypochondrium. Labs showed Hb 7.9g/dl, ANC 96%, platelets 10,000/microlitre, aPTT 75 seconds, total bilirubin 7.3mg/dl, ALP 201IU/L, total protein 4.4gm/dl, creatine 5.5mg/dl, lactate 3.8mmol/l, procalcitonin 25.4ng/ml, D dimer 3800ng/ml. There was no history of alcohol use disorder, acetaminophen/herbal medication overuse. Infectious workup revealed positive leptospira IgM. CT chest showed bilateral ground glass opacities, pleural effusion. CT abdomen showed bilateral acute pyelonephritis. Patient required vasopressors for septic shock, and intermittent hemodialysis for renal failure. Leptospirosis was treated with doxycycline, meropenem. His symptoms resolved in ** days with the recovery of platelet count, creatine levels, LFT. He was extubated and did not require long-term hemodialysis.

Discussion: Leptospirosis is a zoonotic disease and usually presents with a subclinical or self-limited febrile illness. Fulminant hepato-renal-hemorrhagic syndrome in a patient in an endemic area must raise the suspicion for Weil’s disease.


Disclosures:


Azha Fatima, MBBS¹, Fateen Shareef, MBBS², Aishwarya Alugani, MBBS³, Ratnachary P, MBBS, MD³. P4770 - Veiled in plain sight, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.