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Abstract: SA-PO074

A Case of Fulminant Leptospirosis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Yadav, Sakshi, Boston Medical Center, Boston, Massachusetts, United States
  • Menn-Josephy, Hanni, Boston Medical Center, Boston, Massachusetts, United States

Leptospirosis, the most prevalent zoonosis worldwide, is a disease that has historically had low reported cases in the United States. However, recent discussions have focused on the re-emergence of Leptospirosis in this region.

Case Description

We present the case of a 69-year-old Hispanic male who presented with acute onset abdominal pain, fever, and muscle cramps persisting for three days. The patient was found to have acute kidney injury(with a creatinine of 3.3 mg/dL) and promptly initiated on intravenous fluids and empiric antibiotics. Urinalysis revealed mild proteinuria and hematuria, with microscopic examination of the urine sediment showing a few red and white blood cells, few granular casts, and rare white blood cell casts cellular casts. A 24-hour urine protein collection yielded a result of 452 mg. Despite antibiotic therapy, the patient continued to experience daily fevers, excessive night sweats, and severe myalgias and continued to deteriorate with worsening nonoliguric kidney injury (creatinine level peaked at 5mg/dL). He developed thrombocytopenia (platelet count nadir of 45) and hyperbilirubinemia (total bilirubin 6mg/dL with direct bilirubin 4mg/dL), despite otherwise normal liver function. The patient had markedly elevated inflammatory markers with an erythrocyte sedimentation rate (ESR) of 104 mm/hour, C-reactive protein (CRP) of 226 mg/dL, and a fibrinogen level of >800 mg/dL. Complement (C3 and C4) levels, creatine kinase, were within the reference range, and serological/autoimmune workup was negative.
Subsequent renal biopsy revealed predominant acute interstitial nephritis and some focal acute tubular injury. An infectious workup confirmed the presence of Leptospira DNA. The patient was initiated on doxycycline therapy, leading to symptom resolution and improvement of multiorgan failure.


Leptospirosis, previously regarded as a rural disease primarily affecting tropical regions, is now increasingly reported in urban areas and temperate climates. Factors such as weather changes, population growth, and habitat encroachment have heightened the risk of human exposure to Leptospirosis and its carriers. Therefore, in cases of fulminant multiorgan failure with presumed infectious etiology, clinicians should consider Leptospirosis as a potential cause. Timely initiation of treatment can prevent the progression of chronic kidney disease and, ultimately, end-stage kidney disease.