A Case of Imported Leptospirosis: Rhabdomyolysis and Severe Hyperbilirubinemia in a Traveler Returning From Puerto Rico

Leptospirosis is a zoonosis transmitted through human contact with the urine or fecal material of infected animals. Here, we report the case of a young male who presented with hyperbilirubinemia and rhabdomyolysis after returning from Puerto Rico which was confirmed to be severe leptospirosis. An 18-year-old Caucasian male was admitted due to a four-day history of jaundice, fever, headache, abdominal pain, vomiting, dark urine, and pain in his calves. Two weeks before, in Puerto Rico, he swam in caves and at the shoreline in an area recently impacted by a hurricane. Laboratory studies demonstrated leukocytosis, thrombocytopenia, hypokalemia, acute kidney injury with elevated creatine kinase, and hyperbilirubinemia. Due to clinical suspicion of leptospirosis, a serological test was ordered which was positive for Leptospira IgM. In this case, the history of swimming in caves and on the shoreline a few weeks after a hurricane that caused flooding in the region made leptospirosis the most likely diagnosis. The patient’s condition improved after initiation of intravenous penicillin G, 8 million units/day, with a resolution of symptoms after completing a seven-day course of antibiotics. Bilirubin started to trend down on day seven, and the patient was discharged on day eight of hospitalization with minimal jaundice. It is important to obtain a detailed medical history when treating patients who have returned from tropical areas, as leptospirosis can mimic other diseases and can be easily mistaken or underrecognized in non-endemic regions, such as the continental United States.