E0033 - Icteric Leptospirosis Leading to Multiorgan Failure and Concomitant Pancreatitis

Award: Presidential Poster Award

Justin P. Canakis, DO, Michael Bechara, MD, Francis Carro Cruz, MD, Jacyln E. Kagihara, MD, Samuel A. Schueler, MD
George Washington University, Washington, DC

Introduction: Leptospirosis is a zoonotic disease caused by Leptospira interrogans with relatively higher prevalence in tropical regions.¹ The clinical presentation of leptospirosis ranges from asymptomatic to multiorgan failure with complications including aseptic meningitis, renal failure, liver failure, pulmonary hemorrhage, acute respiratory distress syndrome, and dysrhythmias.² Cases of pancreatitis are rare.³ We present a case of leptospirosis causing acute kidney and liver injury, dysrhythmias, and pancreatitis.

Case Description/Methods: A 36-year-old male with a history of schizoaffective disorder and polysubstance misuse presented with bilateral calf pain and pruritis for one week. He denied recent alcohol use or travel. Vitals were normal except for heart rate of 118 beats per minute. Exam revealed scleral icterus and calf tenderness. Laboratory findings showed leukocytosis, thrombocytopenia, elevated creatinine, transaminase elevation, hyperbilirubinemia, and elevated lipase (Table 1). Lower extremity ultrasounds were normal. Magnetic resonance cholangiopancreatography showed mild fatty infiltration without bile duct dilatation and edema around the pancreatic head and neck consistent with pancreatitis.

The patient developed pleuritic chest pain with mild troponin elevation, B-type natriuretic peptide elevation, and ST segment elevations in the lateral leads (Table 1). He then developed anuria and hypotension requiring vasopressors, steroids, and hemodialysis. His bilirubin peaked at 40 milligrams/deciliter. Leptospirosis antigen and polymerase chain reaction (PCR) were obtained, and ceftriaxone was empirically started. He improved with normalization in hemodynamics, urine output, bilirubin, transaminases, and renal function. Leptospirosis antigen and PCR resulted positive.

Discussion: In reflection, our patient’s chief complaint was bilateral calf tenderness which is a distinguishing physical finding.² He had signs of severe leptospirosis including renal, hepatic, and cardiac dysfunction. Interestingly, our patient also had pancreatitis. From 2002 to 2019, only 17 cases of leptospirosis-related pancreatitis have been published and were largely localized to Central Europe and Sri Lanka with just one case coming from North America.^3,4 This patient’s life-threatening illness underscores the importance of recognizing the variable clinical presentation of leptospirosis, particularly in temperate climates with lower prevalence.



Disclosures:


Justin P. Canakis, DO, Michael Bechara, MD, Francis Carro Cruz, MD, Jacyln E. Kagihara, MD, Samuel A. Schueler, MD. E0033 - Icteric Leptospirosis Leading to Multiorgan Failure and Concomitant Pancreatitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.