Icteric Leptospirosis with Acute Kidney Injury, Hepatic Dysfunction, and Rhabdomyolysis

Abstract Leptospirosis, a spirochetal zoonosis caused by pathogenic Leptospira species, may manifest as a mild illness but can progress to Weil’s disease – a severe form characterized by jaundice, acute kidney injury, hemorrhagic complications, and rhabdomyolysis. We report the case of a 31-year-old previously healthy male who presented with a 5-day history of 5 days of fever, malaise, body aches, difficulty walking, and jaundice. Laboratory studies showed marked leukocytosis, hyponatremia, elevated creatinine, marked hyperbilirubinemia with transaminitis, and evidence of rhabdomyolysis. Imaging revealed increased hepatic echogenicity. A positive Leptospira immunoglobulin M serology and urine PCR confirmed severe icteric leptospirosis (Weil’s disease). The patient’s clinical course was complicated by renal failure requiring hemodialysis, as well as hepatic dysfunction and rhabdomyolysis. With prompt antibiotic therapy using doxycycline and ceftriaxone, along with aggressive supportive care, his renal and hepatic parameters improved, and he was eventually discharged in stable condition. Severe leptospirosis remains extremely rare in high-income settings yet carries a substantial case fatality rate. This case highlights the importance of early recognition and treatment, particularly given its nonspecific presentation, potential for rapid deterioration, and public health relevance in the context of emerging zoonoses.