Title : Leptospirosis revealed by acute pancreatitis: A case report
Abstract:
Leptospirosis is an interna3onally distributed zoonosis caused by the pathogenic Leptospira species and is usually transmiKed through mucocutaneous contact with environments contaminated with the urine of infected animals. It has a wide clinical spectrum from a selflimi3ng flu-like disease to the fatal Weil’s disease, which is defined by hepa3c dysfunc3on (jaundice), renal failure, and hemorrhagic symptoms. Acute pancrea33s is one of the less common condi3ons and is associated with a severe extrahepa3c illness that is underreported and underdiagnosed, and is even fatal. We describe a 45-year-old male butcher who presented with epigastric abdominal pain radia3ng to the back, fever, vomi3ng, jaundice, and gingival bleeding. As described, the pa3ent presented with flu-like nonspecific symptoms. Clinical and laboratory examina3on was significant for microcy3c anemia (Hb: 6 g/dL); acute renal failure (urea: 2.01 g/L; crea3nine: 37.5 mg/L); and inflammatory markers were elevated, along with other severe signs of systemic infec3on. On contrast-enhanced abdominal CT scan showed a necro3zing pancrea33s with a modified CT severity index (mCTSI) of 10, with pleuropericardial effusion. Anuria, hemodynamic instability, and secondary infec3ous pneumonia were present in the clinical course. Immediate management by high-dose intravenous ceariaxone and fluoroquinolones and suppor3ve measures (dialysis and blood transfusions, fluid resuscita3on, steady return of oral nutri3on) was started. Aaer 15 days of improvement, the pa3ent was discharged clinically stable. Serological analysis with Microscopic Agglu3na3on Test (MAT) and polymerase chain reac3on (PCR) against 16S rRNA indicated leptospiral infec3on. The case emphasizes early iden3fica3on and treatment of atypical manifesta3ons of leptospirosis. Acute pancrea33s, although rare, may exert a high toll on pa3ents and should be considered in cases of febrile jaundice, abdominal pain, and renal impairment, especially in areas of exposure and occupa3onal prevalence risk groups. Early diagnosis through PCR and aggressive ini3a3on of an3microbial therapy may ensure a beKer outcome. This event contributes to the small number of reported cases associa3ng leptospirosis with necro3zing pancrea33s and emphasizes the need for increased clinical vigilance of this rarely occurring complica3on.
