Jaundice, renal failure and pulmonary haemorrhage in a canal boat owner

Leptospirosis is a rare notifiable disease with three major clinical manifestations: subclinical disease, a self limiting illness (90% cases) and Weil's disease, a fulminant, life-threatening condition with renal and hepatic failure, haemorrhagic pneumonitis and cardiovascular collapse. Diagnosis is by the detection of IgM antibodies to leptospira produced 7 to 14 days after the onset of illness. It is important for acute physicians to consider this condition in their initial differential diagnosis since early treatment reduces the severity and duration of symptoms and hospital stay. A history of environmental or occupational exposure to animals or potentially infected water should raise suspicions of leptospirosis. This article aims to remind clinicians of the diagnosis and management of this condition. The typical symptoms and signs are illustrated by a recent case which presented to our department.