Leptospirosis with Weil disease — DTM&H MCQ

Correct answer: C — Leptospirosis with Weil disease

The correct answer is C, Leptospirosis with Weil disease. This man has the classic triad of fever, jaundice and acute kidney injury following floodwater exposure in a leptospirosis-endemic area, with conjunctival suffusion and severe calf myalgia, both recognised discriminating features of leptospiral infection. Weil disease is the severe icteric form, driven by direct nephrotoxic and hepatotoxic effects of Leptospira, and typically follows exposure to water contaminated with infected rodent urine, exactly the exposure described. The combination of renal failure (creatinine 265 micromol/L), thrombocytopenia and jaundice after freshwater or floodwater contact is highly specific for this diagnosis and is the pattern taught for tropical medicine exams. Why the other options are wrong: B. Acute schistosomiasis: causes Katayama fever with eosinophilia, urticaria and hepatosplenomegaly after weeks, not an acute febrile illness with jaundice, renal failure and conjunctival suffusion within days of floodwater contact. D. Q fever pneumonia: follows livestock or aerosol exposure, presents with atypical pneumonia or hepatitis, and does not cause conjunctival suffusion, calf pain or this renal pattern. A. Brucellosis: acquired from unpasteurised dairy or livestock contact, has an insidious course with undulant fever, arthralgia and hepatosplenomegaly rather than acute renal failure and conjunctival suffusion. E. Dengue without warning signs: causes thrombocytopenia and fever but not jaundice, significant renal impairment or prominent calf myalgia, and by definition excludes severe organ involvement. Key point: Fever plus conjunctival suffusion, severe calf pain, jaundice and acute kidney injury after floodwater exposure is the classic exam pattern for leptospirosis (Weil disease).

Reference: UpToDate: Leptospirosis: Epidemiology, microbiology, clinical manifestations, and diagnosis (2025) - compatible tropical medicine syndromic criteria: fever with conjunctival suffusion and calf myalgia, or unexplained jaundice with acute kidney injury, as leptospirosis-compatible presentations. https://www.uptodate.com/contents/leptospirosis-epidemiology-microbiology-clinical-manifestations-and-diagnosis/print