Weil's syndrome

Severe leptospirosis characterized by jaundice, renal failure & hemorrhage. Mortality is high. Clinical manifestations: 1) onset of illness similar to less severe cases of leptospirosis 2) jaundice, renal failure & hemorrhage develop after 4-9 days 3) hepatomegaly & right upper quadrant tenderness 4) splenomegaly (20%) 5) renal failure often develops in 2nd week a) acute tubular necrosis (ATN) b) dialysis may be required c) renal function may completely recover 6) pulmonary involvement a) cough b) dyspnea c) chest pain d) blood-tinged sputum 7) hemorrhagic manifestations a) epistaxis b) petechiae c) purpura d) ecchymoses e) severe GI bleeding, adrenal & subarachnoid hemorrhage rare 8) other manifestations: - rhabdomyolysis, hemolysis, pericarditis, congestive heart failure (CHF), cardiogenic shock, adult respiratory distress syndrome, multiorgan failure Management: 1) penicillin G 1.5 million units IV QID for 7 days 2) ampicillin 1 g IV QID for 7 days 3) erythromycin 1 g IV QID for 7 days

General

leptospirosis liver disease renal failure; kidney failure lung disease syndrome

References

Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1036-38