Weil's Disease: A Rare Cause of Jaundice

Satiya, Jinendra; Gupta, Neena; Parikh, Malav P.

doi:10.7759/cureus.8428

Cited by 5 publications

(7 citation statements)

References 11 publications

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“…The abdominal pain may be secondary to acalculous cholecystitis and/or pancreatitis. The presence of jaundice demonstrates a poor prognosis with a mortality of 19.1% [ 4 ]. Most cases of leptospirosis-induced pancreatitis are self-limiting and will resolve.…”

Section: Discussionmentioning

confidence: 99%

“…It has the potential to be fatal in some cases; in autopsy reports, specimens have shown congested sinusoids and distension of the space of Disse, which is located between the sinusoids and hepatocytes [ 3 ]. It is important to monitor these patients closely as they can develop fulminant liver failure [ 4 ]. Shintaku et al [ 6 ] reported a case where an autopsy showed severe damage in zone 3 (centrilobular region) and evidence of extreme necrosis of the hepatocytes with extensive hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…Common gastrointestinal symptoms include jaundice, nausea, vomiting, diarrhea, and abdominal pain. The presence of jaundice demonstrates a poor prognosis with a mortality of 19.1% [ 4 ]. Serum aminotransferase levels usually do not exceed five times the upper limit of normal.…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case of Weil’s Syndrome With Extreme Hyperbilirubinemia in an Urban Setting

Ansari¹,

Bhargava²,

Elagami³

et al. 2023

Cureus

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Rare Case of Weil’s Syndrome With Extreme Hyperbilirubinemia in an Urban Setting

Ansari¹,

Bhargava²,

Elagami³

et al. 2023

Cureus

View full text Add to dashboard Cite

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“…Documented to last for up to 30 days, the immune phase typically begins from 7–10 days after the first onset of symptoms [ 36 ]. Satiya et al [ 160 ] emphasized that untreated leptospirosis can lead to fatal hepatic manifestations, such as jaundice. Liver failure, kidney failure and respiratory shock are also notable complications of severe leptospirosis.…”

Section: Transmission and Pathogenesismentioning

confidence: 99%

“…Despite ongoing research efforts, the pathophysiological mechanism of leptospirosis remains poorly understood. However, it is theorized that this disease occurs as a result of the host immune response towards the organisms, which by now should be excessively abundant in the blood, liver, lungs, kidneys, cerebrospinal fluid and the aqueous humour among other organs [ 160 ]. As leptospires bind to host cells, cytokines (interleukin-6, interleukin-10 and TNF-α) and antimicrobial peptides (AMPs) are released to limit the invasive damages incurred by the bacteria.…”

Section: Transmission and Pathogenesismentioning

confidence: 99%

Leptospiral Infection, Pathogenesis and Its Diagnosis—A Review

et al. 2021

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Leptospirosis is a perplexing conundrum for many. In the existing literature, the pathophysiological mechanisms pertaining to leptospirosis is still not understood in full. Considered as a neglected tropical zoonotic disease, leptospirosis is culminating as a serious problem worldwide, seemingly existing as co-infections with various other unrelated diseases, including dengue and malaria. Misdiagnosis is also common as non-specific symptoms are documented extensively in the literature. This can easily lead to death, as the severe form of leptospirosis (Weil’s disease) manifests as a complex of systemic complications, especially renal failure. The virulence of Leptospira sp. is usually attributed to the outer membrane proteins, including LipL32. With an armament of virulence factors at their disposal, their ability to easily adhere, invade and replicate within cells calls for a swift refinement in research progress to establish their exact pathophysiological framework. As an effort to reconstitute the current knowledge on leptospirosis, the basis of leptospiral infection, including its risk factors, classification, morphology, transmission, pathogenesis, co-infections and clinical manifestations are highlighted in this review. The various diagnostic techniques are also outlined with emphasis on their respective pros and cons.

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ST-elevation myocardial infarction, severe cardiogenic shock, and myocarditis secondary to leptospirosis: A rare case report

et al. 2023

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Background: Leptospirosis is a bacterial infection that can lead to several organ dysfunctions. However, cardiac involvements in leptospirosis are uncommon findings. The unknown pathogenesis and association between leptospirosis and cardiac involvements can lead to a diagnostic challenge and case rarity. This study aims to report a diagnosis challenge through physical and laboratory examination of a patient with ST-elevation myocardial infarction (STEMI) and myocarditis without common leptospiral-associated organ dysfunction features. We also report the therapeutic strategies in this case, despite its clinical guideline limitation. Case: A 35-year-old male patient came to the emergency department with flu-like symptoms. Twenty-four hours later, the patient showed acute angina, STEMI, and elevated high-sensitivity cardiac troponin followed by cardiogenic shock without significant modifiable and non-modifiable risk factors for heart diseases. The patient received fibrinolytic, supportive therapy and correction of hemodynamic derangement. We found thrombocytopenia on the second day. Surprisingly, the immunoserology showed positive anti-leptospira IgM and negative anti-dengue IgM and IgG. Further, there was echocardiography suspected myocarditis due to high echogenicity in the left ventricle's basal-apical lateral endocardium. Thus, we diagnosed this case as leptospirosis with cardiac involvement. Direct cardiac tissue damage due to systemic vasculitis, disseminated intravascular coagulation, and pro-inflammatory cytokine storm is believed to be pathomechanism in leptospirosis with cardiac involvement. After diagnosis establishment, his final therapies in the hospital were Aspirin, Atorvastatin, Clopidogrel, Spironolactone, Ramipril, Carvedilol, Omeprazole, Doxycycline, and Ceftriaxone. Subsequently, he was discharged from hospital and continued to receive cardiovascular medications, antibiotics, antiplatelet, potassium-sparing diuretics, and omeprazole. Conclusion: This case highlights the importance of thorough clinical-laboratory evaluation in a patient with an atypical leptospiral presentation. Although leptospirosis is not a common cause of heart diseases such as STEMI, cardiogenic shock, and myocarditis, we recommend supportive therapy and correction of hemodynamic derangement for leptospirosis with cardiac involvement, in addition to leptospiral antibiotic drug itself.

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Weil's Disease: A Rare Cause of Jaundice

Cited by 5 publications

References 11 publications

A Rare Case of Weil’s Syndrome With Extreme Hyperbilirubinemia in an Urban Setting

A Rare Case of Weil’s Syndrome With Extreme Hyperbilirubinemia in an Urban Setting

Leptospiral Infection, Pathogenesis and Its Diagnosis—A Review

ST-elevation myocardial infarction, severe cardiogenic shock, and myocarditis secondary to leptospirosis: A rare case report

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