SHM Converge Scientific Abstract ePoster Gallery-Weil Weil Weil, What Do We Have Here?: An Infectious Cirrhosis Mimic

Pdf Summary

This case describes a 62-year-old man with asthma and moderate alcohol use disorder who presented with six days of fatigue, headache, pleuritic chest pain, epigastric/right upper quadrant pain, nausea, vomiting, and 20-pound weight loss. He had jaundice, scleral icterus, and oral petechiae, with marked laboratory abnormalities including severe thrombocytopenia, hyperbilirubinemia, elevated liver enzymes, and acute kidney injury. Initial imaging with MRCP showed no biliary obstruction, and other causes of thrombocytopenia were excluded.<br /><br />The patient worked as a building superintendent and reported recent exposure to rats, raising concern for leptospirosis. Although serum and urine PCR testing were negative, leptospira serum IgM was positive, supporting the diagnosis. He was treated with a seven-day course of doxycycline, after which his symptoms and thrombocytopenia resolved.<br /><br />The report emphasizes that leptospirosis is a zoonotic infection increasingly reported in New York City, likely related to rat urine exposure. It can present as either anicteric or icteric disease. Icteric leptospirosis, also called Weil’s disease, may cause rapidly progressive multiorgan illness, thrombocytopenia, and a DIC-like picture, with significant mortality and potential pulmonary complications. Thrombocytopenia is noted as a rare presenting feature.<br /><br />A key teaching point is that negative PCR testing does not rule out leptospirosis because organism detection may be transient. Clinicians should maintain a high index of suspicion, especially in patients with rodent exposure and unexplained thrombocytopenia and hyperbilirubinemia, even when more common hepatobiliary causes have been excluded.

Asset Subtitle

Bishoy Gad

Meta Tag

Author List Adarsha Selvachandran, Arvind Dev, Bishoy Gad

Category Clinical Vignettes

Concept Leptospirosis

Concept Doxycycline

Concept Jaundice

Concept Hyperbilirubinemia

Concept Thrombocytopenia

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center

Presenting Author Bishoy Gad

Track Adult

Keywords

leptospirosis

Weil disease

thrombocytopenia

hyperbilirubinemia

rat exposure

zoonotic infection

acute kidney injury

doxycycline

jaundice

New York City

Leptospirosis

Doxycycline

Jaundice

Hyperbilirubinemia

Thrombocytopenia