A Rare Case of Weil’s Disease Presenting With Severe Hyperbilirubinemia and Acute Kidney Injury: A Diagnostic Challenge in Urban England

Abstract

We present a rare and challenging case of Weil's disease in a patient who was admitted to the Critical Care Unit with a clinical suspicion of the condition. The patient showed a prompt response to treatment before laboratory confirmation was obtained. Leptospirosis, a zoonotic disease, is most commonly found in tropical and temperate regions. While it is uncommon in the UK, it carries the potential for severe complications if not treated promptly. We report a 57-year-old gentleman from the North of England with no previous past medical history of note who presented with febrile illness and jaundice. His symptoms included fever, abdominal pain, and poor eating and drinking. Investigations showed raised inflammatory markers and deranged liver function tests (LFTs) with a hepatitic picture. Common causes of deranged LFTs including viral hepatitis, excessive alcohol intake, and paracetamol poisoning were excluded. In addition, CT abdomen and magnetic resonance cholangiopancreatography (MRCP) showed no obstructive lesions. He was admitted to the Intensive Treatment Unit (ITU) for monitoring due to impending multiorgan dysfunction. More elaborative history suggested leptospirosis, and he was treated empirically with intravenous ceftriaxone. Leptospira IgM and polymerase chain reaction (PCR) came back positive indicative of severe leptospirosis. He improved remarkably while in the ITU and was discharged to the ward and then home a few days later. In conclusion, we want to highlight leptospirosis as a cause of fulminant acute hepatitis with potential multiorgan failure and should be suspected even in urban regions when other common causes of hepatitis are excluded.