2024 Volume 73 Issue 4 Pages 800-806
A 60-year-old man resented to our hospital with jaundice, ocular conjunctival hyperemia, liver dysfunction, kidney dysfunction, and low platelet counts. Abdominal ultrasonography (AUS) findings showed suggestion of acute hepatitis, including decreased brightness of the liver parenchyma, relative clarity of the internal vasculature, a collapsed gallbladder lumen, and marked thickening of the gallbladder wall. The blood test showed elevated levels of total bilirubin (T-Bil) and biliary enzymes, with only slight elevations in hepatic transaminases such as AST and ALT. The CT scan showed significant edematous thickening of the gallbladder wall, but no stones were detected in the common bile duct. On the 4th day of admission, AUS findings showed a normal morphology of the gallbladder. In contrast to the decreased biliary enzymes in the laboratory findings, T-Bil levels had risen to 13.96 mg/dL on the 11th day of admission. Leptospirosis was suspected based on his varied clinical symptoms, elevated biliary enzymes, markedly elevated T-Bil, and behavioral history. On the 15th day of admission, the patient was diagnosed with Weil’s disease (severe form of leptospirosis) based on positive antibodies and clinical symptoms such as ocular conjunctival hyperemia, jaundice, and acute kidney dysfunction. In addition to the elevated levels of bilirubin concentration and biliary enzymes activity, the discrepancy between acute hepatitis-like in AUS findings and nonsignificant elevated hepatic enzyme activity in the blood test is important for suspecting leptospirosis, leading to early diagnosis and treatment.
