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Images of Memorable Cases: Case 101

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk. E-mail the authorsEdited By: Frederick Moody

http://rup.rice.edu/memcases-button.jpg

Case_101-pres1-1.jpg

This severely ill 22-year-old man had the abrupt onset of headache, distressing myalgia, shaking chills, and rapid collapse. On examination, he was delirious, with a temperature of 104° F.

Blood from this man grew Leptospira icterohemorrhagiae, prompting therapy with high-dose intravenous penicillin. After a course characterized by renal and hepatic failure, the patient ultimately made a full recovery. He presumably became infected through contact with the urine of rats that infested his home.

The diagnostic clue in this case is the combination of icteric sclerae and hemorrhagic conjunctivae; hence the term “icterohemorrhagiae.”

Leptospirosis presents in various ways, from inapparent to fulminating and fatal disease. About 90% of symptomatic patients manifest a mild influenza-like illness that typically resolves uneventfully within two to three weeks. Only a small proportion develop hemorrhagic complications or hepatorenal failure, and of those, only 10% to 20% die.

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