P1142 - Leptospirosis Misdiagnosed as Alcoholic Hepatitis

Faizan Khalid, MD¹, Mohammad Bilal, MD², Nida Khalid, MD², Karin Dunnigan, MD^2
1Emory University School of Medicine, Atlanta, GA; ²Rochester General Hospital, Rochester, NY

Introduction: Leptospirosis is an often underestimated bacterial infection, with a tendency for underdiagnosis. The clinical manifestations and severity of the disease exhibit significant variability, thereby posing challenges in establishing an accurate diagnosis.

Case Description/Methods: A 36-year-old male with a history of alcohol use disorder abruptly stopped drinking. 5 days later, he presented with fever, fatigue, watery diarrhea, vomiting, decreased urine output and yellow eyes. During this time, his oral intake was minimal, and he was using ibuprofen. At the time of admission, the patient was hemodynamically stable, with a fever of 99°F.

The workup revealed the following abnormalities: WBC 14, Hgb 11, plt 71 and normal PT/INR. LFTs showed AST 75, ALT 45, Alk phos 93, total bilirubin 17( direct bilirubin 14). Other results included serum albumin 3.2, lipase 81, Cr 5.6, BUN 68, Na 132, K 3.2, uric acid 10, & CK 1519. Urinalysis showed proteinuria & granular casts. The patient tested negative for acute viral hepatitis, blood cultures, HIV, EBV, HSV, CMV, ANA, ASMA, Anti-LKM, and had normal IgG levels. Testing for Wilson's disease and hemochromatosis was negative. Ultrasound & MRCP showed a normal liver size and echotexture without biliary duct dilation or gallstones.

The patient was diagnosed with alcohol withdrawal and probable alcoholic hepatitis. ATN due to diarrhea and volume depletion was suspected, although NSAID-induced acute kidney injury was also considered. Steroids were not started due to low MDF score and AKI. The patient received intravenous hydration, thiamine, folate, and multivitamins. However, the direct bilirubin continued to rise, reaching a peak total bilirubin of 34 and renal function did not improve. Despite negative blood cultures, the patient continued to experience intermittent fever. This raised suspicion of leptospirosis (Weil's disease). Further inquiry revealed that the patient had a pet snake at home and fed it with frozen feeder rats. Empiric treatment with piperacillin and tazobactam was initiated after sending a leptospirosis IgM test, which turned out to be positive. Patient was treated with doxycycline for 7 days resulting in rapid clinical recovery.

Discussion: This case report serves to raise awareness regarding the potential consequences of misdiagnosing leptospirosis, emphasizing its potential fatality when left untreated. It is strongly advised to obtain a detailed patient history and maintain a high index of suspicion for this disease.


Disclosures:


Faizan Khalid, MD¹, Mohammad Bilal, MD², Nida Khalid, MD², Karin Dunnigan, MD². P1142 - Leptospirosis Misdiagnosed as Alcoholic Hepatitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.