P2931 - Leptospirosis: Unveiling the Intricacies of a Zoonotic Infection in Pancreatitis

Alexander Alfaro, MD, Mark Miranda, MD, Zeyn Mirza, MD, Diego Roman-Colon, MD, Jose Martin-Ortiz, MD, FACG
VA Caribbean Healthcare System, San Juan, Puerto Rico

Introduction: Leptospirosis is an acute zoonotic infection with a worldwide distribution that often is under-reported. It usually affects young males due to their working or recreational activities and during the rainy season. Humans usually are incidentally infected after exposure to contaminated water, soil or animal urine. The clinical course of this disease is variable as it involves a broad spectrum of clinical manifestations. The emergence of pancreatitis as a severe form of the infection, warrants immediate medical attention.

Case Description/Methods: Case of a 63-year-old Puerto Rican male who presented to emergency department five days after Hurricane Fiona due to acute onset of severe abdominal pain, diarrhea, headaches, chills, myalgias, and anorexia. Physical examination with non-radiating epigastric abdominal pain. Laboratory studies revealed increasing trend lipase 843 to 1064. Concurrently, elevated liver enzymes, leukocytosis, mild thrombocytopenia, and moderate hyponatremia. Sonographic imaging yielded no evidence of gallstones. Despite negative imaging a diagnosis of pancreatitis was established due to the presence of abdominal pain and positive pancreatic enzymes. Complicating matters, on the second day of hospitalization, the patient experienced a sudden fever spike, accompanied by yellowing of the sclera. Initiation of ceftriaxone treatment yielded an unexpected reaction of marked chills and fever, which was managed with antipyretic medications. Further exploration into the patient's history unraveled a crucial piece of the puzzle: exposure to rodent feces during hurricane preparations. This revelation led to suspicion of a Jarisch Herxheimer reaction. The suspicion was corroborated when the Leptospira DNA test confirmed the diagnosis; he completed a course Ceftriaxone and was discharged home.

Discussion: It is important to consider leptospirosis in the differential diagnosis of acute febrile illness. This case underscores the importance of considering pancreatitis in patients with abdominal pain and Leptospira infection. Timely identification and management are paramount and vigilance regarding potential complications is crucial. Recognizing pancreatitis as a consequence of leptospirosis is essential to prevent outcomes such as necrotizing pancreatitis, pseudocyst formation and acute respiratory distress syndrome (ARDS). Raising awareness of this critical complication is pivotal in ensuring improved patient outcomes


Disclosures:


Alexander Alfaro, MD, Mark Miranda, MD, Zeyn Mirza, MD, Diego Roman-Colon, MD, Jose Martin-Ortiz, MD, FACG. P2931 - Leptospirosis: Unveiling the Intricacies of a Zoonotic Infection in Pancreatitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.