A rare case of Weil’s disease with acute pancreatitis and acute kidney injury: focus on management – a case report

Abstract

Introduction and importance: The clinical spectrum of leptospirosis ranges from subclinical infection and anicteric fever to Weil’s disease, a severely fatal infection. Acute inflammation of the pancreas is a rare manifestation of Weil’s disease, and renal involvement is a hallmark in severe forms, leading to acute kidney injury (AKI) and representing a major risk factor for death. The aim of the case report was to present the clinical manifestations of Weil’s disease with acute pancreatitis and AKI and to highlight the management of its complications. Case presentation: A 22-year-old male patient presented to the hospital with a chief complaint of a persisting fever, abdominal pain, nausea and vomiting, decreased appetite, malaise, and urine and feces discoloration. The patient’s residence had flooded 2 weeks ago. Laboratory tests were performed and the patient was diagnosed with Weil’s disease with the complication of acute pancreatitis, AKI, hyperkalemia, hyponatremia, hypotonic hypovolemic, metabolic acidosis, and hypoalbuminemia. Clinical discussion: The patient was treated with intravenous (i.v.) ceftriaxone at a dose of 2×1 g, i.v. metoclopramide at a dose of 3×10 mg, i.v. calcium gluconate at a dose of 1 g followed by dextrose (D) 40% with insulin 2 IU for six times, avoided nephrotoxic drugs, and fluid balance was maintained at I=O+500 ml. The patient received hemodialysis due to refractory hyperkalemia. Posttreatment follow-up presented improvements in complaints and laboratory parameters. Conclusion: Management of severe leptospirosis or Weil’s disease with the complication of acute pancreatitis and AKI requires antibiotics and supportive therapy including adequate fluid resuscitation, proper and adequate nutrition, as well as the initiation of hemodialysis.