SHM Converge Scientific Abstract ePoster Gallery-Leptospirosis in the City: A Case Report

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This case report describes leptospirosis in a 58-year-old undomiciled man in New York City with no significant past medical history. He presented with acute malaise, jaundice, oliguria, and marked laboratory abnormalities, including severe acute kidney injury, hyperbilirubinemia, hyponatremia, thrombocytopenia, and leukocytosis. Although his symptoms improved and renal function recovered over the hospital course, bilirubin and white blood cell counts continued to rise, prompting further evaluation. Extensive imaging, including ultrasound, CT, and MRI, along with a broad serologic workup, was unrevealing.<br /><br />A repeat social history revealed likely rodent exposure because the patient had been sleeping near a dumpster. This raised concern for leptospirosis, a zoonotic infection associated with poor sanitation and exposure to contaminated water or animals. Empiric doxycycline was started and leptospirosis serology was sent. After discharge, Leptospira IgM returned positive, confirming the diagnosis.<br /><br />The report highlights several key teaching points. Leptospirosis can present with a wide range of severity, from subclinical infection to life-threatening multi-organ involvement such as Weil’s disease, with manifestations including jaundice, acute kidney injury, rash, conjunctival suffusion, thrombocytopenia, hematuria, myocarditis, pulmonary hemorrhage, and meningitis. Diagnosis can be difficult because the illness is biphasic, with an initial febrile bacteremic phase followed by an afebrile immune phase. In non-travelers, leptospirosis is uncommon in the U.S. outside Puerto Rico and Hawaii, making it easy to miss.<br /><br />The case underscores the importance of a thorough social history and early consideration of non-endemic infections, especially in patients with housing insecurity and possible environmental exposure risks.

Asset Subtitle

Natasha Qureshi

Meta Tag

Author List Natasha Qureshi, Patricia Dharapak

Category Clinical Vignettes

Concept Leptospirosis

Concept Zoonotic Infection

Concept Rodent Exposure

Concept Serology

Concept Social History

Distinguished Non-Finalist

Presenter Organization Mount Sinai Beth Israel

Presenting Author Natasha Qureshi

Track Adult

Keywords

leptospirosis

Weil's disease

acute kidney injury

jaundice

rodent exposure

housing insecurity

New York City

doxycycline

Leptospira IgM

zoonotic infection

Leptospirosis

Zoonotic Infection

Rodent Exposure

Serology

Social History