Leptospirosis revealed by acute pancreatitis: A case report

Leptospirosis is an internationally distributed zoonosis caused by the pathogenic Leptospira species and is usually transmitted through mucocutaneous contact with environments contaminated with the urine of infected animals. It has a wide clinical spectrum from a self- limiting flu-like disease to the fatal Weil’s disease, which is defined by hepatic dysfunction (jaundice), renal failure, and hemorrhagic symptoms. Acute pancreatitis is one of the less common conditions and is associated with a severe extrahepatic illness that is underreported and underdiagnosed, and is even fatal. We describe a 45-year-old male butcher who presented with epigastric abdominal pain radiating to the back, fever, vomiting, jaundice, and gingival bleeding. As described, the patient presented with ?u-like nonspecific symptoms. Clinical and laboratory examination was significant for microcytic anemia (Hb: 6 g/dL); acute renal failure (urea: 2.01 g/L; creatinine: 37.5 mg/L); and in?ammatory markers were elevated, along with other severe signs of systemic infection. On contrast-enhanced abdominal CT scan showed a necrotizing pancreatitis with a modified CT severity index (mCTSI) of 10, with pleuropericardial effusion. Anuria, hemodynamic instability, and secondary infectious pneumonia were present in the clinical course. Immediate management by high-dose intravenous ceftriaxone and ?uoroquinolones and supportive measures (dialysis and blood transfusions, ?uid resuscitation, steady return of oral nutrition) was started. After 15 days of improvement, the patient was discharged clinically stable. Serological analysis with Microscopic Agglutination Test (MAT) and polymerase chain reaction (PCR) against 16S rRNA indicated leptospiral infection. The case emphasizes early identification and treatment of atypical manifestations of leptospirosis. Acute pancreatitis, although rare, may exert a high toll on patients and should be considered in cases of febrile jaundice, abdominal pain, and renal impairment, especially in areas of exposure and occupational prevalence risk groups. Early diagnosis through PCR and aggressive initiation of antimicrobial therapy may ensure a better outcome. This event contributes to the small number of reported cases associating leptospirosis with necrotizing pancreatitis and emphasizes the need for increased clinical vigilance of this rarely occurring complication.