A Challenging Case of Weil's Syndrome in New York City: A Short Review of the Renal Pathophysiology and Diagnosis of Leptospirosis

Abstract

Leptospirosis is a zoonotic spirochetal infection endemic to warm climate regions, with increased incidence following rainfall and flooding when sanitation is compromised. In comparison, infection rates in the United States are significantly lower. The bacterium is transmitted through the urine of infected animal reservoirs, most commonly rodents, dogs, horses, and pigs, through mucosal membranes or skin abrasions. Leptospirosis can affect multiple organ systems, with severity ranging from asymptomatic cases to life-threatening multiorgan failure. Patients may exhibit a biphasic course, initially experiencing mild illness followed by a brief recovery and then progressing to more severe symptoms such as jaundice, meningitis, renal failure, or pulmonary hemorrhage. Weil's disease is the severe form of leptospirosis, characterized by hepatic dysfunction and renal failure, and is associated with high mortality. We present a case of Weil's disease in a lifelong New York resident who required renal replacement therapy, including both continuous veno-venous hemodialysis (CVVHD) and intermittent hemodialysis (iHD), and ultimately made a full recovery.