Leptospirosis presenting with Acute Kidney Injury: Case Report

Öz

Leptospirosis is very common in tropical regions, with 73% of cases occurring in this region, particularly in South-East Asia, Eastern Sub-Saharan Africa, the Caribbean, and Oceania. Farmers in contact with livestock and exposed to rodents in their workplaces and people living in areas with poor sanitation are at the highest risk. Case: A 47-year-old male patient presented to the emergency room complaining of weakness, fever, nausea, and vomiting that continued for 4-5 days. He was found to be hypotensive (blood pressure arterial 83/55 mmHg) and tachycardic (pulse: 125 beats/minute) at admission. The patient, who had no history of chronic disease, was engaged in farming. In the laboratory tests performed in the emergency room, Leukocyte counts were 7470 103/µL, hemoglobin 13.4 g/dL, and platelet: 15000 103/µL in the complete blood count. Biochemistry parameters: urea:113 mg/dL, creatinine: 2.5 mg/dL, AST:138 IU/L, ALT:80 IU/L, total bilirubin: 6.29 mg/dL, direct bilirubin: 3.78 mg/ dL, LDH:264 IU/L, c-reactive protein: 322 mg/L were detected. The patient was consulted for infectious diseases. Thus, It was recommended to send salmonella, brucella, and leptospirosis samples, as well as hepatitis A-B-C, toxoplasma, cytomegalovirus (CMV), and ebstein barr virus (EBV) serology. The patient was started empirically with doxycycline 2x100 mg/PO and ceftriaxone 2x1gr iv with their recommendations. The leptospirosis PCR test was positive on the 5th day of his treatment. Liver function tests, bilirubin, kidney function tests, and acute phase reactants decreased to normal values with antibiotic treatment. Discussion The diagnosis of leptospirosis is made based on the presence of questionable clinical features with a history of risk exposure. Renal failure is often non-oliguric and is associated with hypokalemia. Supportive renal replacement therapy may be required in the acute phase, but renal function recovery is rapid and complete after six months. In our case, the platelet count was 15,000 103/µL at admission and back to normal values within one month of the treatment. Leptospirosis, a zoonotic disease, should be considered in the differential diagnosis in patients presenting with acute kidney injury, thrombocytopenia, hyperbilirubinemia, liver function test disorders, and acute phase reactant elevation.

Anahtar Kelimeler

• leptospirosis
• acute kidney injury
• hyperbilirubinemia

Kaynakça

1. Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, Stein C, Abela-Ridder B, Ko AI. Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Negl Trop Dis. 2015 Sep 17;9(9):e0003898. doi:10.1371/journal.pntd.0003898. PMID: 26379143; PMCID: PMC4574773.
2. Levett PN. Leptospiroz . Clin Microbiol Rev 2001 ; 14 : 296 – 326.
3. Haake DA, Levett PN. Leptospirosis in humans. Curr Top Microbiol Immunol 2015;387:65–97.
4. Adler B, de la Pena Moctezuma A. Leptospira and leptospirosis. Vet Microbiol 2010;140:287–96.
5. Trevejo RT, Rigau-Perez JG, Ashford DA, et al. Epidemic leptospirosis associated with pulmonary hemorrhage - Nicaragua, 1995. J Infect Dis 1998;178:1457–63.
6. Rajapakse S. Leptospirosis: clinical aspects. Clin Med (Lond). 2022 Jan;22(1):14-17. doi:10.7861/clinmed.2021-0784. PMID: 35078790; PMCID: PMC8813018.
7. Daher, E. D. F., Abreu, K. L. S. D., & Silva Junior, G. B. D. (2010). Leptospirosis associated acute kidney injury. Brazilian Journal of Nephrology, 32, 408-415.
8. Alian S, Davoudi A, Najafi N, Ghasemian R, Ahangarkani F, Hamdi Z. Clinical and laboratory manifestation and outcome of icterohemorrhagic leptospirosis patients in Northern Iran. Med J Islam Repub Iran. 2015 Dec 15;29:308. PMID: 26913271; PMCID:PMC4764287.

9. Puca E, Abazaj E, Pipero P, Harxhi A, Ferizaj R, Como N, Puca E. A case with high bilirubinemia and hemolytic anemia during leptospirosis and a short review of similar cases.Caspian J Intern Med. 2020 Fall;11(4):441-445. doi: 10.22088/cjim.11.4.441. PMID:33680388; PMCID: PMC7911769.