Fulminant Acute Liver Failure Secondary to Leptospirosis: A Case Report
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Abstract
Background: Leptospirosis is a worldwide zoonosis caused by pathogenic species of the genus Leptospira. Although most infections are mild or self-limited, severe forms may progress to multiorgan dysfunction, including acute kidney injury, pulmonary hemorrhage and, less frequently, fulminant acute liver failure. Early diagnosis is often challenging because of the nonspecific clinical presentation, which makes timely antimicrobial therapy crucial to improve outcomes.
Case Presentation: We report the case of a 31-year-old man who presented with fever, progressive jaundice, marked direct hyperbilirubinemia, severe transaminase elevation and rapidly progressive fulminant acute liver failure complicated by hepatic encephalopathy, coagulopathy, septic shock, acute kidney injury requiring renal replacement therapy and lower gastrointestinal bleeding. Initial investigations for viral hepatitis were negative and autoimmune hepatitis was initially considered. The microscopic agglutination test (MAT) subsequently identified Leptospira interrogans serovar Mankarso at a titer of 1:800, establishing the diagnosis of severe leptospirosis. Antimicrobial therapy was adjusted to ceftriaxone plus doxycycline, together with intensive supportive care, and the patient was ultimately referred to a tertiary center for liver transplantation evaluation.
Conclusion: This case highlights fulminant acute liver failure as an uncommon but life-threatening manifestation of leptospirosis. Clinicians should maintain a high index of suspicion in patients presenting with acute liver failure and compatible epidemiological risk factors, even when an infectious etiology is not initially apparent. Early recognition and prompt antimicrobial treatment remain essential to improve clinical outcomes.
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