CASE

PRESENTATION
PRECEPTOR: Dr Rhodora Rhea Lao
Polestico
 TABLE OF CONTENTS

01 02 03 04 05
GENERAL LABORATO SALIENT DIFFERENTI IMPRESSION
DATA RY FEATURES AL
RESULTS DIAGNOSIS
 GENERAL DATA

• NAME : S.M.
• AGE : 41
• SEX : Male
• ADDRESS : Jade valley, Davao city
 CHEIF COMPLAINT

Anuria (Absence of urine formation <100ml )

 HISTORY OF PRESENT ILLNESS

• 5 days PTA, the patient had onset of fever (Pyrexia), chills, headache and
myalgia, temporarily lysed with paracetamol and naproxen. No change in
bowel nor bladder habits.
• In the interim, body malaise and intermittent febrile persisted .He stayed at
home and tolerated the condition.
• 1 day PTA, the patient noted decreased urine output(oliguria) and jaundice,
hence sought consultation. Work up done and was eventually advised for
admission. However the patient refused.
• On the day of admission, the patient noted anuria, and recurrence of
headache prompted consult to SPMC. No signs of melena, hematuria,
petechiae, ecchymosis, no cough, chest pain, respiratory distress.
 PAST MEDICAL HISTORY
• No previous covid(-) HTN, DM, PTB, BA
• (-) Maintenance medicactions
• (-) previous hospitalizations nor
surgeries
• (-) food and drug allergies

COVID HISTORY
• Fully vaccinated
• No recent exposure to COVID cases
• No recent travel infection
 FAMILY MEDICAL HISTORY
• (-) HTN, DM, PTB, BA
• There is no familial history of cancer

PERSONAL AND SOCIAL HISTORY

• 2 Pack year smoker
• Occasional alcoholic beverage drinker
• Denies illicit drug use
• works as a construction worker
• (-) History of wading of floods as claimed
 REVIEW OF SYSTEMS
• GENERAL : (-) recent weight change, (+) FATHIGUE
• SKIN : (-) Rash, (-) itching
• HEAD : (+) HEADACHE, (-) Dizziness
• EYES : (-) itching, (-) discharge
• EARS : (-) discharge,(-) decreased hearing
• NOSE AND SINUS : (-) nasal congestion, (-) nose bleeds
• THROAT : (-) sore throat, (-) hoarseness
• NECK : (-) pain, (-) stiffness
• BREAST : (-) nipple discharge, (-) pain
• RESPIRATORY : (-) difficulty in breathing, (-) cough
• CARDIOVASCULAR : (-) palpitations, (-) chest pain
• GASTROINSTINAL : (-)nausea, (-) rectal bleeding
• PERIPHERAL VASCULAR : (-) edema, (-) leg cramps
• URINARY : (-) Hematuria, (-) dusuria
• GENITAL : (-) discharge, (-) pain
• MUSCULOSKELETAL : (-) joint pain, (+) CALF
TENDERNESS
• PSYCHIATRIC : (-) depression, (-)nervousness
• NEUROLOGIC : (-) changes in mood, (-) numbness
• HEMATOLOGIC : (-) easy bruising, (-) past transfusions
• ENDOCRINE : (-) heat/cold intolerance, (-) increase/decrease
appetite
 PHYSICAL EXAMINATION
• GENERAL : AWAKE, ALERT, NOT IN RESPIRATORY
DISTRESS
• VITAL SIGNS : BP 90/40, HR 111bpm, RR 22cpm, TEMP 36.9C
O2 SATURATION 94% AT ROOM AIR
• HEENT : (+) CONJUNTIVAL SUFFUSION, ANICTERIC
SCLERAE, PINK PALPEBRAL CONJUNCTIVAE, DRY LIPS
AND ORAL MUCOSA, (-) CLAD, NON DISTENED NECK
VEINS.
• CHEST AND LUNGS : EQUAL CHEST EXPANSION, CLEAR
BREATH SOUNDS, ADYNAMIC PRECORDIUM, DISTINCT
HEART SOUNDS, NO MURMURS
• ABDOMEN : SOFT, NON DISTENDEDMABDOMEN, (-)
DIRECT TENDERNESS, EPIGASTRIC AREA, (-) KPS
• EXTREMITIES : FULL PULSES, NO BI PEDAL EDEMA,
(+) CALF TENDERNESS, NO EXTERNAL LESIONS/
WOUNDS.
• NEURO : GCS15
 LABORATORY
RESULTS

• Anemia
• Thrombocytopenia
• Leukocytosis with neutrophilia
• High CRP in blood is a marker of inflammation
• High procalcitonin and LDH level indicates serious
bacterial infection such as sepsis or meningitis
• High serum creatinine and BUN is a sign of kidney
damage
• High serum direct bilirubin and alkaline phosphatase is
a sign of liver damage
• Partially compensated metabolic acidosis.
 SALIENT FEATURES
• 41 years old male from Jade Valley

• Came with a chief complaint of anuria

• He had Onset of fever,chills, headache, myalgia from 5days PTA and temporarily lysed with
paracetamol and naproxen

• no change in bowel/bladder habits.

• Body malaise and intermittent fever persisted at intervening time. No consultation done.

• 1day PTA, patient noted decreased urine output and jaundice. Consultation done but refused to
admit.

• On day of admission patient noted anuria and recurrence headache

• 2 pack year smoker and occasional alcoholic beverage drinker with no food or drug
allergies

• Works as construction worker

• COVID history: fully vaccinated, no recent exposure to covid cases, no recent travel, no
previous COVID infection
• Patient-awake, alert,not in respiratory distress, GCS-15(Glass-cow coma score)
• Conjunctival suffusion -characterized by redness of the conjunctiva that resembles
conjunctivitis, but it does not involve inflammatory exudates which is an eye finding
occuring early on leptospirosis caused by Leptospira interrogans
• Calf tenderness
• By lab results he had leukocytosis and neutrophils( acute bacterial infections).
• Patient had anemia
• Patient had elevated levels of procalcitonin levels, creatine, blood urea nitrogen
indicating acute renal injury

• He had thrombocytopenia.

• He had evidence of hepatitis which can be found by elevated serum concentrations of

unconjugated bilirubin.

• ABG results shows partially compensated metabolic acidosis

 Differential Diagnosis
Leptospirosis

RULE IN RULE OUT

fever and chills Vomiting 

Headache  Abdominal pain
Myalgia
Jaundice
 Yellow fever

RULE IN RULE OUT

Fever Nausea
Headache Vomiting
Jaundice Dizziness
Myalgia

Dengue fever
RULE IN RULE OUT

Headache  Nausea 
Fever Vomiting
Myalgia Rash
Anuria Arthralgia
 Rickettsial disease
RULE IN RULE OUT

Fever and chills Nausea

Malaise Vomiting
Myalgia Rash

Influenza
RULE IN RULE OUT

Fever Sore throat

Headache Runny nose
Malaise Cough
 IMPRESSION
SEVERE LEPTOSPIROSIS (WEIL’S DISEASE) by
Leptospira interrogans bacterium.

The presence of fever, chills, headache, myalgia, calf tenderness, body

malaise, conjunctival suffusion correlates well with the septic stage of the
weil’s disease. And the presence of jaundice, anuria, recurrent headache
correlates with the toxic stage of weil’s disease.

Also the elevated WBC count with neutrophilia, elevated CRP and
procalcitonin levels, thrombocytopenia, partially compensated metabolic
acidosis, elevated serum creatinine and BUN levels supports the diagnosis of
weil’s disease.
 ANIMAL RESERVOIR
(RODENTS , WILD/DOMESTIC
ANIMALS
ENVIRONMENT CONTAMINATED
BY URINE OF ANIMAL RESERVOIR
LEPTOSPRIA ENTERS THROUGH
ABRADED SKIN OR MUCOUS
MEMBRANE EXPOSURE TO URINE
(HUMAN-INCIDENTAL HOST)
(INCUBATION PERIOD 1-2 WEEKS)
OCCUPATIONAL RISK FACTORS -
VETERINARIANS,SLAUGHTER HOUSE
WORKERS, RICE FIELD, RODENT
CATCHERS , SEWAGE WORKERS
VASCULITIS
DAMAGE TO SMALL
BLOOD VESSELS
LEPTOSPIRES ENTERS THE
BLOOD STREAM AND SPREAD
TO ALL ORGANS BODY
HIGH GRADE OF ANICEENTRIC
FEBRILE ILLNESS CHARACTERTICS
BY THREE SYMPTOMS FEVER ,
LEPTOSPIREMIA STAGE MYALGIA ,FATIGUE AND THREE
(LASTS FOR 5-7 DAYS) SIGNS CONJUCTIVAL SUFFUSION ,
MUSCLE TENDERNESS AND
LYMPHADENOPATHY
 INTERSTITIAL NEPHRITIS ACUTE RENAL FAILURE

DIRECT CYTOTOXIC INJURY AND

IMMUNOLOGICAL INJURY

DEATH

VASCULITIS
MULTI ORGAN FAILURE

MASSIVE MIGRATION OF FLUID FROM

INTRAVASCULAR TO INTERSTITIAL
COMPARTMENT
ORGAN DYSFUNCTION

ISCHEMIC DAMAGE TO
INTERNAL ORGANS (LIVER, SEVERE LEPTOSPIROSIS
KIDNEY,MUSCLE) HEPATITIS, RHABDOMYOLYSIS, ACUTE TUBULAR NECROSIS
WITH HYPONATREMIA,HYPOKALEMIA, MENINGITIS,
ENCEPHALITIS, ARDS, PULMONARY HEMORRHAGE,
MYOCARDITIS, HEMORRHAGIC MANIFESTATION OF SKIN,
GIT, JAUNDICE
THANK
YOU