Fulminant leptospirosis masquerading as acute gastroenteritis leading to refractory shock and acute respiratory distress syndrome

Abstract

Leptospirosis is a classical zoonotic infection characterised by a wide spectrum of clinical manifestations ranging 
from mild febrile illness to severe multiorgan involvement with fatal outcomes. Diagnosis has always been a challenge for physicians due to its non-specific presentation and its early clinical overlap with other common infections, such as viral febrile illness or acute gastroenteritis. We report a case of a 25-year-old, previously healthy female, who presented with fever, vomiting, and diarrhea and was initially managed as acute gastroenteritis with hypovolemic shock, and was subsequently confirmed to have leptospirosis. Despite aggressive and comprehensive resuscitation, the patient developed multiorgan dysfunction, acute respiratory distress syndrome (ARDS), and refractory shock and ultimately succumbed to the illness. This case is unique due to its deceptive onset as isolated acute gastroenteritis with hypovolemic shock, rapidly evolving into fulminant leptospirosis with ARDS and refractory shock despite the absence of classical exposure risk. This case highlights the importance of early consideration of leptospirosis as a differential for any acute febrile illness, even in urban setups, for prompt diagnosis and treatment to avoid potentially fatal outcomes.