A case of leptospirosis with severe jaundice, thrombocytopenia and renal failure

A 73-year-old-man presented urgently to the emergency department of our hospital demonstrating high fever, anuria, myalgia and severe jaundice on August 19, 2002. Soon after admission to the intensive care unit, he developed shock, hypotension and hypoxia. Mechanical ventilation, a high dose of catecholamine and treatment with several kinds of antibiotics were started. Laboratory data at the time were as follows: WBC 11, 900/mm3, CRP 37.6 mg/dL, Platelet 17, 000/mm3, total bilirubin 10.8mg/dL, BUN 103.8mg/dL, creatinine 4.9mg/dL. Continuous hemodialysis and hemofiltration (CHDF) were also performed due to acute renal failure. Since he was a farmer and showed several characteristic clinical symptoms such as anuria and severe jaundice, leptospirosis was strongly suggested. Therefore, streptomycin was added in the regimen. Then he recovered and was free from mechanical ventilation and CHDF within about a week. He was finally diagnosed as having leptospirosis based on the dramatically elevated serum level of the antibody to Leptospira hebdomadis from negative to ×640 about a week after admission. Renal biopsy, which was performed on the 11th hospital day, showed interstitial nephritis.