Title : A cog in the weil
Abstract:
We present the case of a 46-year-old male with well-controlled HIV infection on antiretroviral therapy who presented with a four-day history of fever, malaise, and jaundice. The patient, a pilot with recent travel to the United Kingdom and prior travel throughout North America, Central America, and the Caribbean, had been taking oral and intramuscular NSAIDs for symptom relief. On admission, he was febrile and tachycardic, with laboratory studies showing elevated creatinine and transaminases. Blood cultures, respiratory viral panel, chest radiograph, and urinalysis were unremarkable, and imaging of the hepatobiliary system revealed no obstruction or structural abnormalities. Broad-spectrum antibiotics were initiated, then de-escalated to doxycycline, while antiretroviral therapy was temporarily withheld due to concern for a possible drug reaction.
Renal biopsy was performed due to persistent renal dysfunction and demonstrated acute tubulointerstitial nephritis. The patient improved clinically on doxycycline, with normalization of liver and kidney function by discharge. Post-discharge serologic testing returned positive for Leptospira IgM antibodies, confirming the diagnosis of Weil’s disease.
This case underscores the diagnostic challenges of leptospirosis, particularly in patients without clear exposure histories, and highlights the importance of early empiric therapy when clinical suspicion is high.
