Massive rhabdomyolysis and multiple organ dysfunction syndrome caused by leptospirosis

We report a case of leptospiral infection in a 63-year-old man who acquired the infection while swimming in canals and streams in Hawaii. The patient' s course was atypical in that he was anicteric and had no evidence of menin gitis when he presented with fever, rapidly progressive and severe rhabdomy olysis, thrombocytopenia, acute renal failure, and respiratory distress syn drome. Although he recovered after a protracted illness, he required major life support, including mechanical ventilation and hemodialysis. Initial an timicrobial therapy was designed to cover major bacterial and atypical path ogens, including leptospires. An in-depth work-up for causes of this catast rophic illness confirmed acute leptospirosis. Although rare, leptospirosis is a potentially lethal infection classically associated with hepatitis, az otemia, and meningitis. Most patients experience self-limited illness, with fever, myalgias, and malaise followed by an immune-mediated aseptic mening itis. A small proportion develop shock and multiple organ dysfunction. Wher eas myalgias are ubiquitous in leptospiral infection, and most patients sho w mildly elevated muscle enzymes, life-threatening rhabdomyolysis is rare. This atypical case is reported to urge clinicians to consider leptospirosis in the evaluation of a patient with cryptogenic sepsis who develops multip le organ dysfunction associated with rhabdomyolysis, Appropriate antimicrob ial therapy, with penicillin or doxycycline, can be life-saving.