A Case of Leptospirosis Presenting With Thrombocytopenia, Acute Liver Failure and Acute Renal Failure

Leptospirosis is a zoonotic infection caused by the spirochaete Leptospira interrogans. Humans usually acquire the organism through contact with contaminated material via mucous membranes or intact skin, although entry is facilitated by skin breaks, such as cuts or abrasions. A vast majority of leptospiral infections are self-limiting; however, in Weil's disease, which is a more severe form of leptospirosis, patients present with symptoms of jaundice, haemorrhage and renal failure. Arguably, prompt identification and diagnosis of leptospiral infections would reduce mortality and improve patient outcomes. This case report covers a 65-year-old male builder with no significant past medical history, residing in a rodent-infested property, who presented with a seven-day history of flu-like symptoms, jaundice, altered mental status, anuria and coffee-ground vomiting. Laboratory investigations revealed thrombocytopenia, acute kidney injury and acute liver injury, consistent with multi-organ dysfunction. Initial clinical suspicion of leptospirosis was supported by collateral history indicating his dog had recently died with jaundice-like symptoms. A diagnosis of leptospirosis was later confirmed by both a positive polymerase chain reaction (PCR) test and a leptospira antibody test. The patient was managed with intravenous antibiotics, renal support via hemofiltration and mechanical ventilation. He achieved full recovery with subsequent normalisation of liver and renal function.