A Rare Presentation of Leptospirosis

Area of Science:

• Infectious Diseases
• Nephrology
• Internal Medicine

Background:

• Leptospirosis is a zoonotic disease with diverse clinical presentations.
• Acute renal failure is a significant complication, often involving interstitial and tubular damage.
• Nephrotic syndrome is a rare manifestation of leptospirosis.

Purpose of the Study:

• To highlight a rare case of leptospirosis presenting as nephrotic syndrome.
• To emphasize the importance of considering leptospirosis in the differential diagnosis of acute kidney injury with nephrotic-range proteinuria.
• To advocate for early diagnosis and treatment of leptospirosis to avoid invasive procedures.

Main Methods:

• Case report of a 42-year-old male with fever, back pain, and periorbital edema.
• Clinical evaluation including laboratory tests (hypertension, thrombocytopenia, acute renal failure, hypoalbuminemia, hypertriglyceridemia, proteinuria >4.00 g/l).
• Renal biopsy revealing mesangioproliferative glomerulonephritis.
• Treatment with ceftriaxone and positive blood PCR for Leptospira.

Main Results:

• The patient presented with symptoms consistent with nephrotic syndrome and acute renal failure.
• Renal biopsy showed mesangioproliferative glomerulonephritis.
• Treatment with ceftriaxone led to rapid clinical improvement, and Leptospira was confirmed by PCR.

Conclusions:

• Leptospirosis can manifest as nephrotic syndrome, a rare but important clinical presentation.
• In endemic areas or with suggestive epidemiological context, leptospirosis should be suspected in patients with nephrotic syndrome and acute renal failure.
• Diagnosis of leptospirosis can preclude the need for renal biopsy in such cases.