Weil's disease: rapid recovery following corticosteroid treatment: a case report

Leptospirosis is a zoonotic infection with a range of clinical findings, ranging from a mild, self-limited illness to a severe, life-threatening disease known as Weil's disease. The role of adjunctive corticosteroid therapy in severe leptospirosis remains controversial. We report a 41-year-old male with a history of intravenous drug use, regular alcohol consumption, and exposure to contaminated freshwater, who presented with fever, myalgia, vomiting, jaundice, thrombocytopenia, and acute kidney injury. Serological testing via the microagglutination test (MAT) was negative at admission, and empirical antibiotic therapy with ceftriaxone was initiated. Despite appropriate antimicrobial treatment and supportive care, including hemodialysis, the patient developed progressive hyperbilirubinemia and persistent thrombocytopenia. A repeat MAT performed one week later confirmed infection with Leptospira interrogans serovar Pomona. Due to ongoing clinical deterioration, methylprednisolone (1 mg/kg/day) was initiated, resulting in a dramatic clinical and laboratory improvement within 24 h. This rapid response suggests a potential role for corticosteroid therapy in selected patients with severe leptospirosis; however, further studies are required to establish its efficacy and safety.