History and admission findings: A 30-year-old student, who worked part-time as a punt-driver, was admitted to the hospital with fever up to 39.5 °C, severe pain in in his lower extremity and the lower back, nausea and jaundice.
Investigations: Physical examination showed jaundice of skin and sclera as well as conjunctivitis of both eyes. Blood examination results indicated high levels of bilirubin (mostly conjugated), C-reactive protein and creatinine. There were no pathological findings in the ultrasound examination except of discrete splenomegaly. Serology revealed Leptospira IgM antibodies.
Diagnosis, treatment and course: The patient was diagnosed with leptospirosis and was treated with intravenous ceftriaxon, intravenous rehydration and symptomatic analgesia. Upon this treatment, the liver and kidney function recovered and the patient could be discharged from the hospital in a good general condition.
Conclusions: Leptospirosis is a zoonosis which is mainly transmitted by urine of infected animals (predominantly rodents). In this case, the disease was presumably transmitted during the patients work as a professional punt-driver on the Neckar River. The course of the disease is mostly mild with flu-like symptoms, but there are also serious courses with live-threatening complications such as liver or kidney failure and an associated high mortality rate.
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