A Rare Presentation of Leptospirosis

Leptospirosis has a wide spectrum of clinical manifestations. Acute renal failure, an important complication, generally involves interstitial and tubular damage. We describe the case of a 42-year-old man who was admitted with fever, back pain and periorbital oedema. He had hypertension, thrombocytopenia, acute renal failure, hypoalbuminaemia, hypertriglyceridaemia and proteinuria >4.00 g/l. The renal biopsy showed mesangioproliferative glomerulonephritis. Due to the epidemiological context and clinical picture, ceftriaxone was started with rapid clinical improvement. Blood PCR for leptospira came back positive. The presentation of leptospirosis as nephrotic syndrome is rare and this diagnosis should be considered before performing a renal biopsy. LEARNING POINTS: Leptospirosis is a zoonosis with a wide spectrum of clinical manifestations including acute renal failure, which is an important complication. Leptospirosis should be considered in a patient with nephrotic syndrome and acute renal failure if the epidemiological context is favourable. Leptospirosis is one of the causes of nephrotic syndrome where a renal biopsy is not indicated.