Weil syndrome coincident with upper gastrointestinal bleeding

Area of Science:

• Infectious Diseases
• Internal Medicine
• Gastroenterology

Background:

• Leptospirosis is a zoonotic infection with diverse clinical manifestations, often mimicking other conditions.
• Early diagnosis and treatment are crucial for favorable outcomes in leptospirosis.

Observation:

• A 48-year-old male presented with gastrointestinal bleeding, acute kidney injury, liver dysfunction, and pulmonary opacities after traveling to the Dominican Republic.
• Clinical presentation included conjunctival suffusion, bradypsychia, asterixis, and flu-like symptoms.
• Initial investigations revealed anemia, leukocytosis, hyponatremia, hyperbilirubinemia, and hyperamylasemia.

Findings:

• Computed tomography showed bilateral diffuse ground glass pulmonary opacities and pleural effusion.
• Gastric biopsies ruled out malignancy and Helicobacter pylori.
• Positive Leptospira serology (IgG 1/1600) confirmed the diagnosis of leptospirosis.

Implications:

• This case highlights the importance of considering leptospirosis in patients with multi-organ involvement and relevant travel history.
• Prompt antibiotic therapy, initiated empirically with meropenem and de-escalated to ceftriaxone, led to clinical and radiological resolution.
• Leptospirosis should be included in the differential diagnosis of unexplained febrile illness with organ impairment, especially in endemic areas.