SHM Converge Scientific Abstract ePoster Gallery-Leptospirosis: A Potential Cause of Sepsis in an Urban Setting

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This case report highlights leptospirosis as an important but often overlooked cause of sepsis in otherwise healthy urban patients. A 25-year-old woman with no significant medical history presented with 3 days of high fevers, headache, diffuse myalgias, neck stiffness, and right upper quadrant tenderness. Initial workup showed leukopenia, anemia, thrombocytopenia, elevated liver enzymes, direct hyperbilirubinemia, and mild periportal edema on CT, but lumbar puncture studies were normal and no clear source of infection was identified.<br /><br />She was treated empirically with broad-spectrum antibiotics, required norepinephrine in the MICU for septic shock, and improved rapidly. Her antibiotics were narrowed to doxycycline after infectious disease consultation recommended testing for several zoonotic and atypical infections, including Leptospira. After discharge, urine Leptospira RT-PCR returned positive, confirming the diagnosis.<br /><br />The report emphasizes that leptospirosis should be considered in septic patients with nonspecific symptoms, hepatitis, and cytopenias, even without obvious animal exposure or travel history. The disease can present in two forms: a milder anicteric biphasic illness with an acute bacteremic phase followed by an immune phase that may include aseptic meningitis, and a more severe icteric form with organ involvement. Because bacteremia is short-lived, serum testing may miss cases; urine RT-PCR is often more useful early in the disease course.<br /><br />Overall, the case underscores the need to include zoonotic infections in the differential diagnosis of unexplained sepsis and supports early molecular testing for leptospirosis.

Asset Subtitle

Andrew D. Zale

Meta Tag

Author List Andrew D. Zale, Niloofar Latifi

Category Clinical Vignettes

Concept Leptospirosis

Concept Sepsis

Concept Urine RT-PCR

Concept Icteric Leptospirosis

Concept Zoonotic Infection

Distinguished Non-Finalist

Presenter Organization Johns Hopkins University School of Medicine

Presenting Author Andrew D. Zale

Track Adult

Keywords

leptospirosis

sepsis

septic shock

urine RT-PCR

zoonotic infection

hepatitis

cytopenias

doxycycline

Leptospira

urban patient

Leptospirosis

Sepsis

Urine RT-PCR

Icteric Leptospirosis

Zoonotic Infection