A case with high bilirubinemia and hemolytic anemia during leptospirosis and a short review of similar cases

Background: leptospirosis is characterized by very diverse clinical manifestations, which may range from flu-like subclinical forms to very severe presentations characterized by multi-organ failure, or to atypical presentations. one of its most aggressive presentations is weil’s disease, characterized by jaundice, hemorrhagic phenomena and renal failure. cases with high bilirubinemia over 30mg/dl are not communes in human leptospirosis. our aims are to present an atypical case presentation of human leptospirosis, characterized by jaundice and hemolytic anemia, and to make a short review in pubmed for similar cases. at the same time we want to emphasize the diversity of the clinical presentation of human leptospirosis. methods: a 54-year-old man presents at the emergency department of the infectious medicine with severe fatigue, nausea, vomiting, and generalized weakness. on exam, he was alert and well oriented; blood pressure was 80/50 mmhg and icteric. first blood examinations confirmed high bilirubinemia, thrombocytopenia and acute renal failure. results: based on anamnestic and clinical evaluations, blood and serology examinations, the patient resulted with leptospirosis. the bilirubin reached 73.4mg/dl. at the same time on pubmed research we found only limited cases with leptospirosis associated with bilirubinemia over 30mg/dl and over less with hemolytic anemia. conclusion: based on our clinical experience, as well as literature data, we suggest that clinicians should have a high index of suspicion in cases of jaundice with exposure possibilities for infectious diseases. connection of high bilirubinemi over then 30mg/dl and hemolytic anemia in human leptospirosis is an unical case report.