(505) The Fast and the Furriest: A Rapidly Evolving Case of Weil Disease From Handling Rats

Introduction: CDC data reports an average of 100-150 cases of Leptospirosis, of which only 50% of those occur in the continental United states, and the remaining in Puerto Rico. The infection can be challenging to diagnose if the patient does not recall an inciting exposure, and due to its varied clinical presentation. Weil’s disease, a severe Leptospirosis infection presents with a triad of acute renal injury, hemorrhage and jaundice. Weil’s disease has reported mortality rates of up to 70%, making early diagnosis and treatment imperative to survival.

Description: A 61-year-old man presented to a community hospital in Chicago with complaints of fever, body aches and diarrhea. He was evaluated and discharged from a university hospital 3 days prior. On representation he had hypotension, acute renal failure, hemoptysis, elevated total bilirubin, and thrombocytopenia. He was admitted to a critical care floor requiring norepinephrine. CT chest revealed ground glass opacities in the upper lobes with nodular tree-in-bud opacities. He was started on empiric antibiotics to cover for a possible community acquired pneumonia. Atypical pneumonia and vasculitis workup were unrevealing. His condition deteriorated with increasing oxygen requirements, worsening renal function, elevated bilirubin to 8.1, and low platelets. He became anuric and jaundiced. The etiology of the patient’s illness remained unclear, so he was tested for numerous viral etiologies, tuberculosis, and ADAMS-T13. With supportive care, pressors were weaned off, bilirubin, platelets, and creatinine showed improvement. Later history revealed that the patient handled dead rats in his backyard a week prior and subsequently handled food without adequate hand hygiene. He was discharged with cefpodoxime and doxycycline to complete the antibiotic course. After discharge, leptospira IgM antibody was positive. Outpatient followup showed a return to baseline and resolution of symptoms.

Discussion: A patient presenting with nonspecific symptoms and worsening multiorgan failure has a wide differential and requires multiple specialties to help determine the cause of a patient’s presentation . Leptospirosis itself is rare, especially around Chicago, and this patient’s sequelae of symptoms and workup demonstrates the extent that Weil’s disease can manifest.