Severe Leptospirosis (Weil’s Disease): An Interesting Case Report

Abstract

Leptospirosis is underrated zoonotic disease caused by pathogenic Leptospira species in warm climate with poor sanitation. It is characterized by varying asymptomatic infection to mild Leptospirosis with severe fulminant disease. Misdiagnosis and management increase the risk of mortality. A rare case study of human Leptospirosis with serum bilirubin over 42 mg/dl, high urea (155 mg/dl), high creatinine (6.5 mg/dl), pulmonary hemorrhage, deranged coagulation profile (INR 3), with severe metabolic acidosis (pH 7.2 in ABGA) in pertinent laboratory findings were noted. Our aim is to present awareness through this unique case of severe human leptospirosis (Weil’s disease) here. Patient is 31 y old male (with occupation history) working in New Delhi, came to hometown Kolkata, India with history of drowsiness (Glasgow Coma Scale, GCS 7), scanty urine (anuria) and respiratory distress. During admission, on examination, the GCS (E2V2M3), heart rate (126/min), blood pressure (78/44 mm of Hg), respiratory rate (38/min), oxygen saturation (SpO2 :86%) capillary blood glucose (CBG; 132 mg/dl) were noted. Apart from clinical examinations, blood/serum reports show hyperbilirubinemia. Urea, creatinine and potassium were very high, indicating acute renal failure. Pulmonary hemorrhage, haematemesis (blood vomit) and melena (gastrointestinal, GI hemorrhage, blood in stool), coagulopathy was noticed after admission. Hemoglobin dropped minimally to 5.7g/dl during hospital stay. All the clinical presentations and biochemical reports revealed high bilirubin, urea, potassium and creatinine; pulmonary hemorrhage, GI bleeding and coagulopathy.  Positive Leptospira antibody (IgM) detected in ELISA. All these tests made a clear diagnosis of severe form of Leptospirosis or Weil’s disease in this patient.