Dr Lucy Marshall1, Dr Lai Chan1
1Nephrology Department, Te Whatu Ora Waikato, Hamilton, Aotearoa / New Zealand
Biography:
Bio to come.
Background:
Leptospirosis is a zoonotic disease caused by the spirochete Leptospira spp., transmitted through direct contact with the body fluid of infected animals. It often presents as a flu-like illness, but up to 10% of cases may progress through a severe immunological response marked by pulmonary haemorrhage, hepatic failure and renal failure, named “Weil’s disease”. The mechanism for renal dysfunction is predominantly through rhabdomyolysis and acute tubular necrosis. Previous case reports rarely describe creatine kinase values above 16,000 units/litre (U/L), the definition of severe rhabdomyolysis, above which the risk of requiring renal replacement therapy increases considerably.
Case Report:
A 54-year-old gentleman developed two days of anuria following a ten-day long gastrointestinal illness. He lived in a tent and drank water from a river contaminated by deceased animals. He was encouraged to present to hospital by concerned family members, despite the ability to perform heavy lifting tasks until the day of admission. On presentation, he was dehydrated and jaundiced with a conjugated hyperbilirubinemia of 372 micromole/litre (µmol/L), creatinine 537 µmol/L, and creatine kinase 25,760 U/L. He was commenced on intravenous ceftriaxone and aggressive resuscitation fluids, but his renal function deteriorated rapidly. He required four sessions of intermittent haemodialysis to treat symptomatic uraemia before entering a renal recovery phase with polyuria. His serum leptospirosis PCR later confirmed the diagnosis of Weil’s disease.
Conclusions:
We report a case of leptospirosis-induced rhabdomyolysis with levels of creatine kinase that have not previously been reported in the literature. This may have been exacerbated by ongoing physical activity throughout our patient’s illness and delays to seeking medical attention.