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CASE REPORT
Behavioural change: a rare presentation of leptospirosis
  1. Isabelle Dominique Tomacruz1,
  2. Joanne Carmela Sandejas2,
  3. Regina Berba3 and
  4. Dennis Raymond Sacdalan4
  1. 1 Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
  2. 2 Division of Infectious Diseases, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
  3. 3 Division of Adult Medicine and Hospital Infection Control Unit, Philippine General Hospital, University of the Philippines, Manila, Philippines
  4. 4 Department of Radiology, Philippine General Hospital, University of the Philippines, Manila, Philippines
  1. Correspondence to Dr Isabelle Dominique Tomacruz, idvtomacruz{at}gmail.com

Abstract

Neurological manifestations of leptospirosis without severe multiorgan involvement are a rare clinical entity. Despite the increasing prevalence of the disease in many tropical countries, its protean clinical presentations make its timely diagnosis challenging. We report the case of a 44-year-old Filipino man presenting with fever, myalgia, behavioural changes and altered sensorium. Neurological examination did not show any focal neurological deficits or clear signs of meningoencephalitis. Lumbar tap, cranial CT scan and cranial MRI were inconclusive. The diagnosis of leptospirosis with acute encephalitis relied heavily on the patient’s clinical clues, appropriate exposure history and patterns in ancillary laboratory tests. Empiric antibiotic therapy with ceftriaxone was initiated. Seroconversion and fourfold increase in serological antibody titres by leptospirosis microagglutination test later confirmed the diagnosis. The patient was successfully treated, and all neurological complications were reversed.

  • tropical medicine (infectious disease)
  • infection (neurology)
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Footnotes

  • Twitter @DTomacruzMD

  • Contributors IDT and JCS were involved in the care of the patient during hospital admission. IDT wrote the initial manuscript and made the necessary revisions. JCS and RB reviewed the manuscript and gave expert opinion. DRS facilitated and reviewed the imaging. All authors were involved in the editing and approval of the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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