SHM Converge Scientific Abstract ePoster Gallery-It Came as a (Septic) Shock: An Unexpected Case of Leptospirosis at an Urban U.S. Hospital

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This case describes a 55-year-old man with hypertension and diabetes who presented with two days of fatigue, myalgias, vomiting, and diarrhea. He worked as a grocery clerk in New York City and had no recent travel or water exposure. On exam, he had bilateral calf tenderness, and he was found to be in atrial fibrillation with rapid ventricular response and septic shock, requiring vasopressors and cardiac care.<br /><br />Initial testing showed enteropathogenic E. coli (EPEC) on stool PCR, which partially explained the diarrheal illness. However, the severity and combination of findings—fever, myalgias, thrombocytopenia, acute kidney injury, marked transaminitis, hyperbilirubinemia, and rhabdomyolysis—raised concern for leptospirosis. Laboratory abnormalities were striking, including creatinine 7.2 mg/dL, AST 1,073 U/L, ALT 516 U/L, CPK 1,882 U/L, and very elevated inflammatory markers. Leptospira IgM serology was negative early in the course, but urine PCR later detected Leptospira DNA, confirming the diagnosis.<br /><br />He was treated empirically with broad-spectrum antibiotics, then doxycycline for seven days. His diarrhea resolved, vasopressors were discontinued, rhythm returned spontaneously to normal sinus rhythm, and hepatic and renal injury improved. He was discharged without residual symptoms.<br /><br />The report emphasizes that leptospirosis can present as a severe febrile gastrointestinal illness and may progress to multisystem dysfunction. Because early serologic testing can be falsely negative, clinicians should maintain a high index of suspicion and consider empiric treatment when the clinical picture is suggestive. The case also highlights that urban residence, especially in crowded settings, may be an underrecognized exposure risk in the United States, even without classic occupational or travel-related risk factors.

Asset Subtitle

Raphael Rabinowitz

Meta Tag

Author List Barbara Jerome, Raphael Rabinowitz

Category Clinical Vignettes

Concept Leptospirosis

Concept Febrile Diarrheal Illness

Concept Multisystem Involvement

Concept Empiric Treatment

Distinguished Non-Finalist

Presenter Organization NYU Grossman School of Medicine

Presenting Author Raphael Rabinowitz

Track Adult

Keywords

leptospirosis

enteropathogenic E. coli

septic shock

acute kidney injury

rhabdomyolysis

transaminitis

thrombocytopenia

atrial fibrillation

urban exposure

doxycycline

Leptospirosis

Febrile Diarrheal Illness

Multisystem Involvement

Empiric Treatment