PT  - JOURNAL ARTICLE
AU  - Ami Schattner
AU  - Ina Dubin
AU  - Yair Glick
AU  - Elizabeth Nissim
TI  - Acute painless pancreatitis as an unusual presentation of leptospirosis in a low-incidence country
AID  - 10.1136/bcr-2020-234988
DP  - 2020 Aug 01
TA  - BMJ Case Reports
PG  - e234988
VI  - 13
IP  - 8
4099  - http://casereports.bmj.com/content/13/8/e234988.short
4100  - http://casereports.bmj.com/content/13/8/e234988.full
SO  - BMJ Case Reports2020 Aug 01; 13
AB  - A healthy, urban-dwelling man presented with lassitude, jaundice without increased liver enzymes or obstructive features on imaging, brief acute kidney injury, leucocytosis with near-normal C reactive protein and markedly increased serum amylase and lipase. Leptospirosis was not considered for 10 days because of the low incidence of the disease in the country, absent animal contact and physicians’ low index of suspicion. Presentation without fever and without the commonly associated abdominal pain, myalgia, headache, thrombocytopaenia or elevated serum creatine kinase added to the diagnostic challenge. Once an infectious cause of acute pancreatitis was contemplated, leptospirosis was immediately sought and diagnosed by PCR of urine and microscopic agglutination test, and he fully recovered on ceftriaxone. Physicians in countries with a low incidence of leptospirosis should be more aware of the possibility of the disease even when several key features such as fever or pain are missing and the patient has a rare infectious acute pancreatitis.