Introduction: Leptospirosis is a rare zoonotic infection in the United States, but severe cases (Weil’s disease) may present with jaundice, renal failure, and pulmonary involvement. Diagnostic delay is common when GI or hematologic causes are presumed. Description: A 44-year-old man with alcohol use disorder was admitted with vomiting, diarrhea, and acute kidney injury (creatinine 6.7 mg/dL). Labs showed thrombocytopenia (platelets 62), elevated direct bilirubin, and modest AST elevation. On day 2, he had coffee-ground emesis followed by hypoxemia requiring BiPAP and intubation. Old blood was noted in the airway. Bronchoscopy triggered atrial fibrillation with HR 190–200 bpm, requiring cardioversion and amiodarone. He developed shock requiring vasopressors and was started on CRRT. Infectious workup revealed norovirus; empiric antibiotics (vancomycin, piperacillin–tazobactam, doxycycline) were initiated. Platelets fell further; TTP was ruled out (no schistocytes, normal ADAMTS13). Hematology recommended dexamethasone for possible ITP. Bilirubin peaked at 34.4 mg/dL. Hepatitis panel, HIV, ANA, ANCA, CMV were negative. Renal biopsy showed acute tubular necrosis without vasculitis. Serum leptospira IgM returned positive. He was diagnosed with Weil’s disease. Ceftriaxone 10-day therapy was started. He improved clinically, was extubated, weaned off vasopressors, and transitioned to intermittent hemodialysis before transfer to rehab. Discussion: Weil’s disease is an uncommon cause of multiorgan failure in the U.S., but should be suspected in patients with acute kidney injury, thrombocytopenia, jaundice, and pulmonary symptoms—especially when initial infectious workup is unrevealing. Alcohol use disorder may increase susceptibility through hepatic dysfunction and mucosal barrier compromise. This case demonstrates the diagnostic complexity of leptospirosis, which initially mimicked GI bleeding, TTP, and alcohol-related liver disease. Timely recognition and antibiotic therapy were critical to recovery. ICU teams should consider leptospirosis in the differential diagnosis of unexplained acute tubular necrosis and pulmonary-renal syndromes.
Abid et al. (Sun,) studied this question.