MON-651 Hyperosmolar Hyperglycemic State Induced by Leptospirosis Infection

Abstract Disclosure: R. Maini: None. K. Oguntuyo: None. D. Alban: None. P.D. Greenberg: None. Background: Leptospirosis, a zoonotic infection caused by spirochetes, can present as Weil’s disease, characterized by fever, jaundice, renal failure, and conjugated hyperbilirubinemia. There is minimal evidence of an association between leptospirosis infection and diabetic emergencies. To date, only one pediatric case from India documented a patient with type 1 diabetes who presented with DKA induced by leptospirosis. Clinical Case: A 49-year-old male with history of type 2 diabetes, obesity, and MASLD presented with altered mental status and jaundice. Laboratory evaluation revealed hyperosmolar hyperglycemic state (HHS), direct hyperbilirubinemia, and renal failure. Initial labs showed glucose of 858 mg/dL with elevated serum osmolality, normal pH, HbA1c 9.7%, creatinine 5.5 mg/dL, AST 68 U/L, ALT 115 U/L, alkaline phosphatase 101 U/L, total bilirubin 10 mg/dL, and direct bilirubin 7.1 mg/dL. The patient had recently started Ozempic 0.25mg weekly and completed 3 doses so far. He also took Metformin daily and did not use insulin at home. During the admission, the total bilirubin peaked at 27.2 mg/dL, direct bilirubin at 21.9 mg/dL, and creatinine at 6.4 mg/dL. Imaging, including CT scan and RUQ ultrasound, ruled out an obstruction, and a HIDA scan revealed delayed tracer clearance and gall bladder dyskinesia. Social history revealed that the patient worked in sanitation, so an infectious disease panel was sent. The patient tested positive for leptospirosis IgM. The patient was initially treated with an insulin drip, normal saline intravenous fluids, and bridged to basal/bolus subcutaneous insulin. He was treated with courses of Zosyn and Doxycycline with improvement in both renal function and bilirubin levels. He was discharged on insulin and Ozempic was discontinued. Conclusion: This is the first case documenting a presentation of HHS in the setting of leptospirosis infection. The clinical course was complicated by isolated direct hyperbilirubinemia and gall bladder dyskinesia, potentially exacerbated by recent Ozempic use. Presentation: Monday, July 14, 2025