SHM Converge Scientific Abstract ePoster Gallery-Acute Leptospirosis as a Cause of Culture-Negative Sepsis

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This case describes a previously healthy 13-year-old girl who presented with 5 days of fever, abdominal pain, vomiting, headache, and joint pain. On exam she appeared ill and fatigued, with conjunctival injection, diffuse abdominal tenderness, and delayed capillary refill. Initial labs showed anemia, thrombocytopenia, hyponatremia, hypokalemia, acute kidney injury, and elevated inflammatory markers. CT imaging revealed diffuse enteritis and extensive bibasilar airspace disease.<br /><br />Because of worsening clinical status, including a new oxygen requirement and progressive anemia and thrombocytopenia, she was treated empirically for culture-negative sepsis with ceftriaxone and metronidazole, and infectious disease was consulted. Blood cultures remained negative. Further history uncovered important exposure risks, including swimming in stagnant water and frequent contact with animal urine at home. A next-generation cell-free DNA test later returned positive for Leptospira, confirming acute leptospirosis.<br /><br />The discussion highlights that leptospirosis is a zoonotic spirochetal infection transmitted through urine from rodents, dogs, and livestock. It is increasingly recognized in the United States despite being classically associated with tropical regions. The illness has two phases: an early septic phase with nonspecific symptoms such as fever, headache, abdominal pain, vomiting, conjunctival suffusion, and myalgias, followed by an immune phase that may include aseptic meningitis, Weil syndrome, pulmonary hemorrhage, and arrhythmias.<br /><br />The patient improved with doxycycline and was discharged on hospital day 6. Key teaching points were that leptospirosis can mimic culture-negative sepsis, diagnosis is often delayed due to nonspecific symptoms, and clinicians should maintain a high index of suspicion in patients with relevant exposure history. Prompt antibiotic treatment can prevent severe complications.

Asset Subtitle

Temitayo Olojo

Meta Tag

Author List Kristen Lewis, Temitayo Olojo

Category Clinical Vignettes

Concept Leptospirosis

Concept Clinical Presentation

Concept Animal Urine

Concept Freshwater

Concept Microscopic Agglutination Test

Distinguished Non-Finalist

Presenter Organization Wexner Medical Center at the Ohio State University and Nationwide Children's Hospital

Presenting Author Temitayo Olojo

Track Pediatric

Keywords

leptospirosis

culture-negative sepsis

zoonotic infection

conjunctival injection

acute kidney injury

thrombocytopenia

fever

animal urine exposure

doxycycline

next-generation sequencing

Leptospirosis

Clinical Presentation

Animal Urine

Freshwater

Microscopic Agglutination Test