Expanded Leptospirosis Syndrome - An Unusual Case

Leptospirosis, caused by Leptospira species, is known for hepatorenal dysfunction in severe cases. Emerging evidence shows atypical manifestations, complicating diagnosis, especially in regions where it mimics other tropical illnesses like Dengue or Malaria. A healthy young female presented with high-grade fever, headache, malaise, vomiting, epigastric pain, and altered sensorium. Examination revealed conjunctival injection, meningeal signs, and abdominal tenderness. Liver function tests showed transaminitis with direct hyperbilirubinemia and albumin reversal, while renal function tests were normal. An ECG showed sinus tachycardia with non-specific ST segment changes. Elevated cardiac biomarkers trended downward with monitoring. Fundoscopy was normal, but a CT scan revealed cerebral edema. Cerebrospinal fluid analysis indicated meningitis, and MRI confirmed meningoencephalitis. Based on clinical findings and modified Faine's criteria, leptospirosis was diagnosed. Multi-organ involvement was evident, excluding renal dysfunction. The patient responded well to treatment and was discharged in stable condition. This case highlights an unusual presentation of leptospirosis with multi-organ involvement but no renal dysfunction. Such atypical cases are increasingly recognized, similar to expanded Dengue syndrome. Early recognition of these presentations is crucial for appropriate management to prevent adverse outcomes. Clinicians must be aware of these evolving patterns for timely diagnosis and improved prognosis.