Vnitr Lek 2012, 58(9):668-673

Morbus Weil - a case study and principles

P. Majdák^1,*, I. Drexlerová¹, M. Staňáková¹, P. Malinjak², J. Melicherík³

¹ Geriatrické oddelenie NsP Bojnice, Slovenská republika, prednosta prim. MUDr. Pavol Majdák

² Infektologická ambulancia NsP Bojnice, Slovenská republika, vedúci lekár MUDr. Peter Malinjak

³ Neurologické oddelenie NsP Bojnice, Slovenská republika, prednosta prim. MUDr. Andrej Mihál

We present a case of a 66 years old man without significant medical history who was admitted to a geriatric department of a local hospital for a critical clinical state with severe icterus (billirubin 368 μmol/l), acute renal failure (urea 48 mmol/l, creatinine 714 μmol/l) and severe thrombocytopaenia. When the patient's son completed his personal history on the 4^th day of hospitalization reporting that the patient had worked in a pub flooded during local floods, we also considered leptospirosis as a potential cause of his current state. Parenteral penicillin antibiotics (amoxicillin + clavulanate) were prescribed and comprehensive infusion rehydration, corrective and haemostyptic treatments were continued. Despite transient worsening of thrombocytopaenia to 8 × 10³/μl, we did not observe any severe bleeding, thrombocytopaenia gradually improved and thrombocyte levels were in the reference range from the 7^th day of hospitalization. Acute renal failure (ARF) did not involve oliguria and an intensive conservative treatment provided gradual improvement of the clinical status as well as laboratory parameters with creatinine levels at discharge of 121.3 μmol/l. Heamodialysis was not used. Billirubin levels also gradually declined to 25 μmol/l at discharge. Leptospiral antibodies in the urine and serum were suggestive of leptospirosis. The diagnosis was confirmed with follow up investigations 13 days after discharge. The condition was caused by Leptospira icterohaemorrhagiae. The patient's condition was complicated with deterioration of pre-existing hearing impairment. We also expect a contribution of leptospirosis to its anamnesis. Antibiotic treatment continued for 16 day, 7 of which with parenteral administration. Haemodynamically stable, normotensive, afebrile, self-sufficient patient was discharged on 37^th day of hospitalization to primary care.

Keywords: leptospirosis; Weil's disease; renal failure; icterus; thrombocytopaenia

Received: December 30, 2011; Accepted: April 27, 2012; Published: September 1, 2012  Show citation