Acute renal failure in a man with a small farm

Leptospirosis is a zoonosis with protean manifestation caused by the spirochete leptospira. The major presenting symptoms arc fever, jaundice, acute renal failure and thrombocytopenia (1). The fact that this patient owns a small farm where he eats unwashed fruits made us consider this diagnostic possibility. The patient was started on ampicillin therapy, received hemodialysis and marked improverilent of renal function followed. The diagnosis was confirmed by leptospira titers that were rechecked after medical treatment obtaining normal values. The annual incidence of Leptospirosis in the United States ranges from 0.02 to 0.04 cases per 100,000 persons, but in tropical countries it can be the cause of acute renal failure in up to 24% of cases. In Puerto Rico the fever, myalgia, thrombocytopenia may lead to its confusion with dengue (2). In 1966, after hurricane Hortense in Puerto Rico, Sanders did leptospira titers in patients following negative dengue serology and concluded that leptospirosis is an underdiagnosed and misdiagnosed disease.