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A5225 - The Jamaican Shuffle
Author Block: W. Memon1, R. V. Patel2, S. Azharuddin1; 1University of Illinois- Urbana- Champagin, Champagin, IL, United States, 2University of Illinois- Urbana- Champagin, Urbana, IL, United States.
Leptospirosis is a zoonotic disease that can have signs and symptoms ranging from mild flu like illness to the dreaded complication of Weil’s disease. A 42-year-old male arrived via ambulance with the concern of altered mental status that started 25 minutes prior to arrival. He was agitated and jaundiced with scleral icterus. He and his wife had recently traveled to Jamaica. The day after returning from his trip; he went to his physician with the symptoms of hoarseness, lethargy, and myalgia. DVT was ruled out and he was subsequently released on the assumption of a muscle strain. Ten days later, he presented to the emergency department with the symptoms tachycardia, jaundice, and found to be hypoxia requiring 15 liters of oxygen. His lung exam revealed bilateral decrease in air entry with coarse crackles. Initial labs on admission revealed a white cell count of 47 X 10⁹/L, platelet count of 101 x 10⁹/L, potassium of 6.1, blood urea nitrogen of 183, and creatinine of 12.4 mg/dl. Arterial blood gas revealed a pH of 7.03, lactic acid of 14.2, procalcitonin 6.3, and troponin 0.22, CT scan of the chest showed diffuse bilateral alveolar infiltrates with ground glass opacities. He quickly decompensated and was transferred to the intensive care unit, intubated, required norepinephrine IV infusion and received dialysis. A computed tomography scans of the abdomen and head were benign. He underwent bronchoscopy with serial washings shortly after intubation, which showed pink fluid consistent with pulmonary hemorrhage. His bronchoalveolar lavage was negative for fungal organisms, malignancy, but was positive for Streptococcus pneumonia and Methicillin-Sensitive Staphylococcus Aureus. Urine cultures were collected which showed legionella and leptospira urine antigens to be negative. He was started on empiric intravenous antibiotics and later placed on Doxycycline despite the negative urine antigen test for leptospirosis. Leptospira DNA qRT-PCR was sent and returned positive within 7 days. He received a total of 3 days of IV Doxycycline and was discharged in excellent condition to his home on a 7-day course of oral Doxycycline.
Discussion: The patient’s presentation of altered mentation, jaundice, acute kidney injury, dyspnea, pulmonary hemorrhage, leukocytosis, metabolic acidosis, and abnormal chest x-ray were features associated with severe Leptospirosis infection i.e. Weil’s disease. It is estimated that seven to ten million people are infected by leptospirosis each year; about 200 reported case in United States each year.