Abstract Introduction Leptospirosis is a spirochete bacterium typically spread through contact with infected animal urine, water or soil. Activities such as gardening, hiking or farming carry a higher risk of being exposed. 5-10% of leptospirosis cases become a severe infection called Weil Syndrome. Weil syndrome commonly presents with myalgias, hyperbilirubinemia, renal failure and hemorrhage. This case aims to highlight an unusual occupation exposure to raise awareness to aid in earlier detection and empiric treatment. Case Presentation A 44-year-old man presented with 5 days of nausea, vomiting, and profound weakness. He had recently started work as a chef and reported eating raw beef and fish 2 days before symptom onset. On arrival, he was febrile, tachycardic, and hypotensive, requiring levophed and ICU admission. Labs showed leukocytosis (13.85 k/uL), thrombocytopenia (51 k/uL), hyperbilirubinemia (3.2 mg/dL), elevated creatine kinase (726 U/L), and oliguric ATN requiring CVVHD. Empiric cefepime and doxycycline were started. Abdominal ultrasound on day 4 showed mild hepatomegaly. Tick-borne panel, ADAMTS13 level, hemolysis labs, HIV screen, hepatitis panel, and blood cultures were negative. His creatinine rose to 6.21 mg/dL, leukocytosis to 26.4 k/uL, bilirubin to 12.2 mg/dL, and platelets declined to 17 k/uL. His course was complicated by nasal and rectal bleeding requiring 4 units of platelets. Leptospirosis IgM and urine PCR returned positive on day 6, prompting initiation of ceftriaxone 2 g daily for 7 days. His creatinine improved to 1.12 mg/dL, leukocytosis to 9.14 k/uL, platelets to 191 k/uL, and bilirubin to 2.1 mg/dL. The patient regained the ability to ambulate and had full renal recovery. Discussion About 100-150 leptospirosis cases are reported annually in the United States, primarily in temperate regions. Negative initial serologies may warrant repeat testing in 7-10 days, while urine PCR is most reliable one week after symptom onset due to risk of early false negatives. Mild disease can be treated with doxycycline, whereas severe cases benefit from IV penicillin or ceftriaxone. Conclusion This case underscores the need for early recognition of possible exposures, given the high mortality of Weil Syndrome. While serology and PCR support diagnosis, clinicians should remain cautious of early false negatives. Prompt treatment should not be delayed, as reliance on laboratory confirmation may risk worsening clinical outcomes. This abstract is funded by: None
Garcia et al. (Fri,) studied this question.