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Severe leptospirosis — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesSevere leptospirosisSCE Acute Medicine

A 39-year-old sewage worker presents with fever, myalgia, conjunctival suffusion and jaundice. Creatinine is 260 micromol/L, bilirubin 118 micromol/L and platelets 64 x10^9/L. He has calf tenderness and mild haemoptysis. What is the most likely diagnosis?

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Correct answer: E — Leptospirosis with Weil's disease

Occupational water exposure, conjunctival suffusion, jaundice, renal failure and thrombocytopenia point to severe leptospirosis. EBV hepatitis would not typically cause this renal-pulmonary syndrome. Gilbert syndrome causes isolated unconjugated hyperbilirubinaemia without sepsis features. The pearl is that conjunctival suffusion is an under-recognised clue in returning or occupational fever.

Reference: https://bnf.nice.org.uk/#acute-medicine-order-75-1