Two Cases of Leptospirosis with Renal Manifestations Seen in One Chicago Community Hospital

Introduction: Leptospirosis is relatively rare in the United States, with one reported case per year in Illinois. It is known to cause renal failure during both the acute and chronic phase via acute tubulointerstitial nephritis or acute tubular necrosis. We present 2 cases of leptospirosis and renal failure found in one community hospital in Chicago. Case Description: Case 1- 61 year old male with history of HTN, PE/DVT who presented for fever, confusion, and anuria. The patient notably handled a dead rodent in his backyard prior to admission. Initial labs showed sodium 124 mg/dL, potassium 3.0 mg/dL, BUN 44 mg/dL, creatinine (Cr) 3.5 mg/dL, platelets 61 mg/dL, TBili 3.9mg/dL, and UA with trace blood and protein. CT Chest/Abdomen/Pelvis revealed endobronchial inflammation,colitis, and bilateral perinephric stranding. He required pressors and was started on ceftriaxone, azithromycin, and metronidazole. Workup for vasculitis, glomerular disease, and TTP/HUS were negative. Infectious workup returned positive for leptospirosis. His Cr peaked at 5.2 mg/dL. He improved with antibiotics and ultimately did not require hemodialysis (HD). Case 2- 45 year old male with no medical history presented with 5 days of fever and neck stiffness. He noted handling a dead rodent prior to symptom onset. Initial labs showed sodium 132 mg/dL, potassium of 2.8 mg/dL, BUN of 48 mg/dL, creatinine 4.4 mg/dL, TBili 3.3 mg/dL, WBC 14.5 mg/dL, and UA with 3+ protein, 3+ blood, and granular casts. Lumbar puncture was obtained with CSF consistent with aseptic meningitis, and PCR returned positive for leptospirosis. His antibiotics were adjusted to IV ceftriaxone. He ultimately required intermittent HD, however his renal function improved with treatment and did not require HD upon discharge. Discussion: These cases highlight the renal manifestations of leptospirosis, the importance of early diagnosis, and suggest it may be more prevalent than previously reported. Having multiple cases in one community hospital in Chicago is suprising. Therefore, increased research and community awareness may be warranted. Moreover, leptospirosis should be considered in the differential for urban patients.These cases highlight the benefits of early diagnosis, as both patients clinically improved and did not remain on HD after treatment.