A Fatal Case of Presumptive Diagnosis of Leptospirosis Involving the Central Nervous System

Abstract

Leptospirosis is a reemerging zooanthroponosis with a worldwide distribution, though it has a higher incidence in areas with tropical climate. A characteristic finding of the disease is its wide spectrum of symptoms and organ involvement, as it can appear either with very mild flu-like manifestations or with multiorgan failure, affecting the central nervous system (CNS) with a concomitant hepatorenal dysfunction (Weil's syndrome) and significant high mortality rate. We report herein a fatal case of a 25 years old female, previously healthy, with impaired neurological status. She had high fever and severe multiorgan failure. The clinical data and the epidemiological factors were not conclusive for the diagnosis, and the first serology test from the cerebrospinal fluid (CSF) and sera samples were negative. When the repetition of the blood test showed elevated IgM antibodies, Leptospirosis was the presumptive diagnosis. Although CNS involvement is rare, the diagnosis should be considered when there is an elevated risk of exposure. The diagnostic protocol should encompass direct evidence of the bacterium and indirect measurement of antibodies. Timely detection and management are imperative to forestall complications and fatality associated with the disease.

Keywords: CNS; Leptospirosis; Weil’s syndrome; case report; coma.

Figure 1

Axial diffusion-weighted imaging (a) and apparent diffusion coefficient map (b) at the level of the convexity, showing increased and decreased signal intensity of the cerebral cortex along both frontal lobes (arrows), respectively. Axial diffusion-weighted imaging (c) at the level of basal ganglia reveals symmetrical hyperintensity of the caudate (white asterisk) and lentiform (black asterisk) nuclei, bilaterally. On the corresponding apparent diffusion coefficient map (d), the same areas appear hypointense.

Figure 2

Axial T1-weighted MR images without (a,c) and after (b,d) administration of intravenous contrast material. An infratentorial leptomeningeal enhancement was noted, most prevalent along the anterior aspect of the temporal lobes (arrows). The findings were suggestive of the presence of meningitis/meningoencephalitis.