A rare case of complicated pancreatitis due to leptospirosis

Acute pancreatitis as a rare complication of leptospirosis: A case report and literature review

Leptospirosis is a zoonotic disease. We present a case of acute pancreatitis associated with leptospirosis. An 88-year-old woman was admitted to the hospital with high fever and severe myalgia of the lower extremities. Based on the clinical presentation, hepatic dysfunction with a mild increase in bilirubin, renal dysfunction, and life history, the possibility of leptospirosis was considered. Plain computed tomography of the trunk on admission revealed no special findings. Appropriate antimicrobial therapy was administered at an early stage. After treatment initiation, the clinical symptoms and blood test abnormalities began to improve, and the patient appeared to be doing well. Although no abdominal or back pain was consistently noted during hospitalization, the serum amylase level increased over time; therefore, the patient underwent another computed tomography scan on the ninth day. Acute pancreatitis, which was absent upon admission, was noted. Appropriate treatment for pancreatitis was administered, and the patient was discharged. A subsequent serum antibody test confirmed the diagnosis of leptospirosis. Herein, we also summarized previous cases of acute pancreatitis associated with leptospirosis. The time of onset for pancreatitis was inconsistent, and there were a few cases of pancreatitis without abdominal or back pain. In contrast, serum amylase or lipase levels were elevated in all patients, which could be an important trigger for suspected complications of pancreatitis. When leptospirosis is suspected, complications of pancreatitis should always be considered, even in the absence of apparent abdominal pain. Regular monitoring of pancreatic enzymes such as amylase and lipase is recommended.

Leptospirosis Associated Digital Gangrene of Lower Extremities: Two Cases and Review of Literature

BACKGROUND

Leptospirosis is the most common zoonotic illness worldwide, caused by pathogenic spirochete bacteria called Leptospirosis. It is clinically presented with mild to moderate in most cases. However, sometimes, the course may be severe with multiorgan dysfunction.

CASE PRESENTATION

We present two rare cases of Leptospirosis with peripheral dry gangrene of the lower extremities. A 25-year-old male, farmer by occupation without any significant past medical history had been diagnosed with a case of Leptospirosis that complicated to digital gangrene on 15 days of illness during hospitalization. Another 21-year-old male student was admitted for leptospirosis and developed digital gangrene on 19 days of illness. All clinical findings were resolved on the steroid.

CONCLUSION

Apart from a high index of suspicion and awareness of unusual manifestations, serology plays a vital role in making an accurate and quick diagnosis to initiate appropriate therapy.