[Fever of unknown origin, head and muscle pain, hemoptysis, hepatosplenomegaly and icterus. 2 case reports]

[Severe febrile illness with renal impairment after travel to Southeast Asia]

HISTORY

A 40-year-old teacher fell ill one week after returning from a two weeks back-packing trip to Thailand and Laos. He developed high fever, severe headache, myalgias and a conjunctivitis.

INVESTIGATIONS

CRP and liver enzymes were elevated. The patient developed acute renal failure. Total leucocyte count was normal but the differential count showed an extreme left shift. Imaging procedures revealed hepato-splenomegaly and enlarged kidneys. TREATMENT, COURSE AND DIAGNOSIS: The patient was treated with moxifloxacin and ceftriaxon based on the initial suspicion of a severe infection potentially due to leptospirosis. This treatment led to a rapid improvement of the patient's condition and also of the laboratory findings. Leptospirosis could be confirmed by the seroconversion of specific antibodies to L. grippotyphosa 2 1/2 weeks after onset of complaints (initial serology negative).

CONCLUSIONS

In febrile travelers returning from Southeast Asia, leptospirosis has to be considered especially in case of severe headache, myalgias, elevated liver enzymes and renal failure and a history of close contact to potentially contaminated water (rivers, lakes). Diagnosis is confirmed by the detection of specific antibodies.