36/M fr Arkansas w fever, epistaxis, headache, myalgia x 5 d in the summer. O/E: icteric sclerae, b/l calf tenderness. WBC 12, Hgb 10, Plt 110. Crea 6, bili 25 (direct), ALT 180, AST 130. HIV (-). He’s MSM, sewer inspector, no recent travel. What is the most likely dx?
(1/6) The majority got the right answer, leptospirosis. 🌟Elevated bilirubin out of proportion to AST & ALT (usually <200 IU) + renal failure ➡️ hallmark of Weil’s disease (severe form of leptospirosis). Other clues: nonpurulent conjunctivitis (suffusion), calf tenderness.🌟
(2/6) Note that Weil’s is a rare manifestation of leptospirosis. The most common SSx are 📌nonspecific (self-limited febrile illness). Other complications: bleeding diathesis, aseptic meningitis, pulmonary hemorrhage. #meded
(3/6) Human infection results from exposure to rodent urine or environmental sources contaminated by rodent urine (during occupational or recreational exposure [📌triathlon runners in Hawaii📌]). Outbreaks a/w flooding, typhoon. #meded
(4/6) Hemorragic-pulmonary-renal syndrome of severe leptospirosis very similar presentation as 🌟hantavirus (also through rodent exposure). Epidemiologic clues can help differentiate (Hantavirus predominantly in southwest US, none in Arkansas as in this case). 🌟 #meded
(5/6) #medhistory In the years before the English Pilgrims settled in Plymouth in 1616-1619, most Native Americans there had died of a mysterious disease characterized by jaundice and epistaxis. New historical analysis points to leptospirosis as the cause. ncbi.nlm.nih.gov/pmc/articles/P…
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