Expanded Leptospirosis Syndrome – An Unusual Case

Leptospirosis, a zoonotic disease caused by Leptospira species, is traditionally associated with hepatorenal dysfunction in severe cases. However, emerging evidence highlights an expanding clinical spectrum with atypical manifestations, complicating diagnosis. Recognizing these varied presentations is crucial, especially in regions where leptospirosis mimics other tropical illnesses like dengue or malaria. We report the case of a previously healthy young female who presented with high-grade fever, headache, malaise, vomiting, epigastric pain, and altered sensorium. On examination, she had conjunctival injection, meningeal signs, and abdominal tenderness. Liver function tests indicated transaminitis with direct hyperbilirubinemia and albuminreversal, while renal function tests were normal. An electrocardiogram showed sinus tachycardia with non-specific ST segment changes. Cardiac biomarkers were elevated but trended down with serial monitoring. Fundoscopy was normal, while a CT scan of the head revealed cerebral edema. Cerebrospinal fluid analysis demonstrated elevated cell counts and proteins, consistent with meningitis. Further imaging with contrast-enhanced MRI confirmed meningoencephalitis. Based on clinical findings and the modified Faine’s criteria, leptospirosis was diagnosed. Multi-organ involvement, including the central nervous system, liver, and heart, was evident, but renal function remained unaffected. The patient responded well to treatment and was discharged in stable condition. This case illustrates an unusual presentation of leptospirosis involving multiple organs without renal dysfunction. Such atypical cases are becoming increasingly recognized, akin to the expanded dengue syndrome where atypical organ involvement is seen beyond the classical features. Both diseases, prevalent in tropical regions, pose diagnostic challenges due to their diverse clinical manifestations. Early recognition of these uncommon presentations is crucial for appropriate management, as delayed diagnosis could lead to adverse outcomes. Clinicians must be aware of these evolving patterns to ensure timely diagnosis and improve patient prognosis.