E0073 - A Misleading Presentation of Gallstone Pancreatitis Caused by Leptospirosis

Paloma Velasco, MD¹, Juan J. Adams Chahin, MD², Natalia Mestres, MD³, Jose Colon, MD^1
1University of Puerto Rico, Internal Medicine Program, San Juan, Puerto Rico; ²University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico; ³University of Puerto Rico Internal Medicine Program, San Juan, Puerto Rico

Introduction: Leptospirosis is a common zoonotic infection with presentation ranging from mild influenza-like symptoms to deadly multi-organ failure. Pancreatic involvement, including isolated hyperlipasemia, is rarely seen in Leptospirosis and is mainly caused by vascular damage. We describe an unusual case of Leptospirosis mimicking gallstone pancreatitis presenting with jaundice, hyperlipasemia, and typical pancreatitis-like clinical features.

Case Description/Methods: A 45 year old male with a past medical history of hypertension presented with a one week evolution of nausea, non-bloody/non-bilious emesis, fever, epigastric pain, pale diarrhea, and anorexia. Vital signs were remarkable for tachycardia. Physical examination revealed bilateral scleral icterus, dry oral mucosa and severe epigastric tenderness. Laboratory workup disclosed stable platelets and hemoglobin, WBC of 24,000/mm³, creatinine of 2.77 mg/dL, with associated azotemia. Liver function enzymes revealed elevated total/direct bilirubin (12.62/11.84 mg/dL), GGT (372 U/L), alkaline phosphatase (143 U/L), and mildly elevated AST with negative viral hepatitis markers. Lipase levels showed increasing trend from 375 to 467 (n= 0-160 U/L). Patient was subsequently admitted under the diagnosis of gallstone pancreatitis for which aggressive IV hydration, IV antibiotics and symptomatic treatment was initiated with little improvement. Abdominal ultrasound revealed hepatomegaly with no biliary ductal dilatation, visible gallstones, or pancreatic abnormalities. Magnetic resonance cholangiopancreatography showed no evidence of cholelithiasis, choledocholithiasis, cholecystitis or pancreatitis. Abdominopelvic computed tomography disclosed no evidence of intra-abdominal pathologies. On day #4 patient presented with bilateral conjunctival suffusion which raised concern for Leptospirosis for which serology was ordered. Patient was initiated on oral Doxycycline therapy with subsequent improvement of symptoms and laboratory parameters. IgM Leptospira antibody test was positive. On day #6 patient left against medical advice.

Discussion: Rare cases have described pancreatitis caused by Leptospirosis without imaging confirmed structural changes of the pancreas which creates a diagnostic challenge for physicians. This case demarcates the importance of Leptospirosis awareness and high clinical suspicion warranted in order to allow for early diagnosis, prevent treatment delay and avoid unnecessary imaging or interventions.


Disclosures:


Paloma Velasco, MD¹, Juan J. Adams Chahin, MD², Natalia Mestres, MD³, Jose Colon, MD¹. E0073 - A Misleading Presentation of Gallstone Pancreatitis Caused by Leptospirosis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.