We present a unique case of Weil's disease, a severe form of leptospirosis caused by Leptospira interrogans, a rare agent seen in both temperate and tropical climates but is more commonly seen in tropical climates and transmitted to humans commonly by rodent urine contamination. It is an under-reported infection, with 1.03 million cases documented annually, and is not commonly found in the United States. A 32-year-old African American male presented with abdominal pain and pressure in his chest associated with nausea, vomiting, and diarrhea. On exam, scleral icterus, sublingual jaundice, and hepatosplenomegaly were noted. Imaging studies revealed the patient had incidental situs inversus and dextrocardia. Labs revealed leukocytosis, thrombocytopenia, transaminitis, and significant direct hyperbilirubinemia of over 30 mg/dL. An extensive workup revealed the patient had leptospirosis due to rat contamination in his apartment. The patient was treated with doxycycline, and his clinical status improved. The heterogeneous and unique clinical presentation of leptospirosis gives rise to a broad differential diagnosis. We aim to encourage physicians who encounter similar presentations in similar urban settings in the United States to include leptospirosis in their differential.
Prostate abscess is a rare complication of prostatitis, typically observed in patients with conditions such as immunodeficiency, diabetes, urinary tract abnormalities, and chronic indwelling catheters. Gram-negative bacteria such as Enterobacteriaceae are the most commonly detected organisms in prostate abscesses. Methicillin-resistant Staphylococcus aureus (MRSA) infections are rarely reported. The unique aspect of our case involves MRSA bacteria, further complicated by an MRSA prostate abscess, in a 61-year-old immunocompetent male. The patient, with a past medical history of hypertension and diabetes, presented to the emergency department complaining of nausea and vomiting for four days, with an associated subjective fever and right-sided abdominal pain. A computed tomography (CT) scan of the abdomen/pelvis with contrast showed a prostatic abscess, with abscess/phlegmon extending bilaterally into the seminal vesicles. Urine and blood cultures were positive for MRSA. Initially, Piperacillin/Tazobactam and Vancomycin were initiated. Subsequently, the treatment was switched to Daptomycin. The patient also underwent cystoscopy with urethral dilation, transurethral prostate resection, and unroofing. Although MRSA is not a typical causative agent of prostatitis, it should be considered in the differential diagnosis, especially when clinical improvement cannot be achieved with standard empirical treatment. Timely identification and appropriate treatment (such as drainage and antibiotics) are crucial for both patient survival and the prevention of complications.
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