Fatal Fulminant Hepatitis Following Leptospirosis : A Case Report

Abstract

Leptospirosis is a bacterial zoonosis that may rarely cause severe hepatic involvement and fulminant acute liver failure. We report a 32-year-old man with no notable medical history who presented after seven days of fever, intense myalgia, headache, and vomiting, with recent exposure to stagnant water following heavy rainfall. His condition deteriorated rapidly, with jaundice, cutaneous-mucosal bleeding, altered consciousness, hypotension, and tachycardia. Laboratory investigations showed marked hepatic cytolysis (AST 5,000 IU/L; ALT 4,200 IU/L), conjugated hyperbilirubinaemia (total bilirubin 280 µmol/L), severe coagulopathy (prothrombin time 18%; INR 4.5), hypoglycaemia, acute kidney injury (creatinine 480 µmol/L), thrombocytopenia, and leukocytosis. Serological testing for hepatitis A, B, C, and E viruses and toxicological screening were negative, whereas Leptospira PCR and IgM serology were positive. Fulminant hepatitis secondary to severe leptospirosis was diagnosed. Intensive care management included a third-generation cephalosporin, haemodynamic support, mechanical ventilation, haemodialysis, and correction of coagulation disorders. Despite these measures, hepatic encephalopathy worsened, refractory septic shock and multiple organ failure developed, and the patient died on the third day of hospitalisation. This case highlights the need to consider leptospirosis early in febrile patients with acute liver failure and compatible water exposure, because severe hepatic involvement may progress rapidly despite intensive supportive treatment and organ support.