Everything You've Always Wanted To Know About Leptospirosis

This is the case of a 23-year-old male from Bulacan who, three days before being admitted to the emergency room, had a 40-degree fever, chills, headache, neck stiffness, productive cough, nausea, and muscle pain.

- GRACE CAROLE BELTRAN, MD

At the time of his initial visit, he denied photophobia (sensitivity to light), rash, abdominal pain, and diarrhea. On physical examination, he was found to be tachycardic (with increased heartbeat) and febrile (38.5°C). He received two liters of normal saline. He was reassessed and found to be hemodynamically stable, then sent home with prescriptions for fever and nausea/vomiting. The patient reported that his fever was controlled with acetaminophen, but his nausea persisted.

Two days after his first ER visit, the patient developed symptoms of photophobia, non-bloody, watery stools, non-bloody, greenish or bright yellow vomitus up to seven times per day, bloody sputum, and dark tea-colored urine.

On the night prior to his second ER visit, the patient also noticed yellowing of his eyes and face and the onset of abdominal pain. The patient admitted swimming in floodwater two weeks before his second ER visit but denied skin abrasions and water ingestion. At the ER, he was started on triple intravenous antibiotics while awaiting blood/sputum/urine/stool cultures, gram stains, and serological test results. The patient developed respiratory distress while at the ER.

He was weaned to supplemental oxygen via nasal cannula and had no further respiratory distress or evidence of recurrent pulmonary hemorrhage. The patient was transferred to the ward but demonstrated jaundice, decreased abdominal stiffness/tenderness to palpation predominantly in the right upper abdomen and epigastric region. Laboratory values of liver enzymes, serum creatinine (a blood test that measures the level of creatinine in the blood, which is a waste product of muscle metabolism), and creatine kinase (enzyme from muscles) all decreased. The patient was started on a clear liquid diet and continued to demonstrate nausea and pain below the rib cage without vomiting.