RT Journal Article
SR Electronic
T1 Behavioural change: a rare presentation of leptospirosis
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e230619
DO 10.1136/bcr-2019-230619
VO 12
IS 8
A1 Isabelle Dominique Tomacruz
A1 Joanne Carmela Sandejas
A1 Regina Berba
A1 Dennis Raymond Sacdalan
YR 2019
UL http://casereports.bmj.com/content/12/8/e230619.abstract
AB 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.