SHM Converge Scientific Abstract ePoster Gallery-From Viral Meningitis Suspicion to Leptospirosis Diagnosis: A Case for Broad Differentials

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This case report describes a 24-year-old man admitted with fever, fatigue, myalgias, nausea/vomiting, headache, thrombocytopenia, acute kidney injury, transaminitis, and mild CSF pleocytosis, initially raising concern for viral meningitis or another infectious emergency. Empiric vancomycin and ceftriaxone were started despite CSF findings suggesting a viral process, and an initial respiratory viral panel was positive for rhinovirus/enterovirus. Over the first several hospital days, his fever resolved and platelets, creatinine, and liver tests initially improved, prompting de-escalation of antimicrobials.<br /><br />On hospital day 6, however, AST and ALT abruptly rose to nearly 1000 U/L with normal bilirubin, shifting concern toward severe hepatocellular injury and prompting reassessment of the differential. Negative viral and tickborne testing, along with diagnostic stewardship including smear assessment, culture, and targeted PCR, led clinicians to revisit zoonotic exposures. Leptospira IgM returned positive, confirming leptospirosis (Weil’s syndrome). The patient’s history of freshwater exposure was a key diagnostic clue.<br /><br />He was treated with penicillin G after doxycycline was avoided due to intolerance, and his liver enzymes began to improve within a day. He completed an 8-day antibiotic course (ceftriaxone followed by penicillin G) and was discharged on hospital day 9 with normalized platelets, improving renal function, and resolving transaminitis.<br /><br />The case emphasizes that leptospirosis should remain on the differential for hospitalized patients with febrile illness, aseptic meningitis, AKI, thrombocytopenia, and hepatocellular injury, even outside tropical settings. It also highlights the value of detailed exposure history, reassessment when clinical patterns change, and hospitalist-led antimicrobial stewardship.

Asset Subtitle

Cheryl W. Zhang

Meta Tag

Author List Adib Alhaddad, Cheryl W. Zhang

Category Clinical Vignettes

Concept Leptospirosis

Concept Freshwater Exposure

Concept Aseptic Meningitis

Concept Acute Kidney Injury

Concept Diagnostic Stewardship

Distinguished Non-Finalist

Presenter Organization NYU Langone Brooklyn

Presenting Author Cheryl W. Zhang

Track Adult

Keywords

leptospirosis

Weil syndrome

acute kidney injury

thrombocytopenia

transaminitis

aseptic meningitis

freshwater exposure

zoonotic infection

hospitalist stewardship

penicillin G

Leptospirosis

Freshwater Exposure

Aseptic Meningitis

Acute Kidney Injury

Diagnostic Stewardship