An Unusual Presentation of Leptospirosis in an urban setting as an - PDF document

Bangladesh Crit Care J March 2019; 7 (1): 51-54 Case Report An Unusual Presentation of Leptospirosis in an urban setting as an overlooked cause of multiorgan failure Md. Tarek Alam 1* , Sadia Saber 2 , Rafa Faaria Alam 3 , Mohammad Monower Hossain 4 Abstract: Leptospirosis is a life-threatening zoonotic disease of global distribution. It has variable presentation ranging from mild febrile illness to life-threatening complications like acute renal failure, acute hepatic failure, pulmonary hemorrhages and cardiac arrhythmias. We present a case of flu-like illness contracted by working at a poorly hygienic place where the patient experienced progressive pulmonary-renal syndrome two days after admission. Index suspicion and early treatment remains the mainstay of this life threatening zoonotic disease. Key Words: Leptospirosis, Weil’s disease, Acute pulmonary hemorrhage, Pulmonary-renal syndrome, Microscopic agglutination test (MAT). Background: dehydrated, jaundiced, tachycardic (pulse rate of 102/min) and a blood pressure of 110/70mmHg. He had generalized Leptospirosis is a potentially fatal zoonotic disease which is muscle tenderness. The skin turgor was senile without rashes caused by the pathogenic spirochete of genus leptospira 1 . It is or wounds over chest, abdomen or back. His conjunctivae characterized by a broad spectrum of clinical manifestations were normal and his sclera was icteric. Abdominal which include subclinical infection, self-limited anicteric examination revealed right hypochondriaI tenderness with febrile illness and a severe and potentially fatal illness known hepatomegaly but no other organomegaly. His heart sound as Weil's syndrome that presents with jaundice, renal failure and breathing sounds were normal. The remainder of his and haemorrhage 2 . It is a disease of worldwide distribution. physical examinations were unremarkable. Human infection occurs either through the direct contact with infected animals or more of the times through the contact with Laboratory results at his admission are given below: water or soil contaminated with urine of infected rodents or Parameters On Admission animals 1 . The definitive diagnosis of leptospirosis is based either on isolation of the organism from clinical specimens or Haemoglobin (g/dl) 7.60 a fourfold or greater rise in antibody titre in the convalescence Total white cells count (10 9 / l) 8.00 phase sera. The management of leptospirosis includes supportive measures and the use of penicillin or tetracycline to Platelets (10 9 /l) 80.00 eradicate the organism. The efficacy of antibiotics remains Sodium (mmol/l) 135 controversial although some studies showed that administration of intravenous penicillin or doxycycline at an Potassium (mmol/l) 3.63 early stage of the illness was beneficial 2 . Creatinine (mg/ dl) 7.1 CASE REPORT: Urea (mg/dl) 240 A previously healthy 55-year-old man came to our emergency Total protein (g/l) 51 department due to fever, generalized myalgia, lethargy and right hypochondrial pain for one-week. He was anuric for 2 Total bilirubin (mg/dl) 28.26 days. On examination he was found to be febrile (38°c), Alkaline phosphatase (IU/l) 84 Alanine transaminase (IU/l) 78 1. Prof of Medicine, Bangladesh Medical College & Hospital, Dhanmondi, Dhaka. Blood and urine cultures, blood film for malarial parasites, dengue serology, and Widal-weil Felix serology tests were all 2. Asstt. Prof of Medicine, Bangladesh Medical College & Hospital, Dhanmondi, Dhaka negative. Ultrasonography of the abdomen showed Hepatomegaly with hypoechoic parenchyma-suggesting 3. Honorary Medical officer, Bangladesh Medical College & Hospital, Dhanmondi, Dhaka hepatitis, bilateral swollen kidney – acute nephropathy, mildly enlarged prostate gland (volume 27cc).The chest radiography 4. Medical Officer of Medicine, Bangladesh Medical College & showed borderline cardiomegaly, with no active lung lesion in Hospital, Dhanmondi, Dhaka. both lung fields. *Corresponding Author: On hospital day 4 at midnight, the patient experienced Dr. Md. Tarek Alam, MBBS, MD (USA) progressive respiratory distress associated with confused Prof of Medicine, consciousness and hemoptysis. The chest radiography showed Bangladesh Medical College & Hospital, Dhanmondi, Dhaka. generalized interstitial infiltrations in both lungs. Acute Email: mtarekalam@hotmail.com Received : October 02, 2018; Accepted : December 24, 2018 51