[Leptospirosis as a differential diagnosis of acute renal failure]

Leptospirosis is a worldwide infectious disease affecting both animals and humans. Leptospira pomona is well known as a pathogen of a mild form of leptospirosis (maladie des jeune porchers).

A 51-year-old male farmer was referred to our hospital with high fever, hyperbilirubinemia and acute renal failure. Further laboratory tests revealed elevated inflammatory parameters, thrombocytopenia, signs of a mild hepatitis and involvement of pancreas. About 7 days before he had experienced muscle pain accompanied by headache and fever. Suspecting leptospirosis an intravenous therapy with penicillin was started. During the subsequent course of his illness a sixfold increase increase of antibody titer against leptospira pomona was documented within 3 weeks. Urine retention parameters decreased by intravenous fluid resuscitation in the intensive care unit, so that hemodialysis was not necessary. Platelets and bilirubin returned to normal. Atrial fibrillation as a sign of cardiac manifestation of leptospirosis changed spontaneously in a regular and permanent sinusrhythm. The patient was discharged home after 3 weeks in the hospital.

Early diagnosis is most important for the prognosis of patients with severe form of leptospirosis. Leptospira pomona is a known pathogen of anicteric leptospirosis but in some cases is able to cause a severe form of leptospirosis with renal failure, jaundice and thrombocytopenia.