Muddy

A 49 year old man presents with intermittent fever, a generalized headache and myalgia particularly prominent in both calves, for 7 days.

He also noticed yellowish discoloration of both eyes for the last 2 days. Further inquiry reveals the passage of dark colored urine for approximately the same duration.

His medical and surgical histories are unremarkable. He does not smoke or consume alcohol.

He travelled to Sri Lanka 1 week ago, where he engaged in trekking and white water rafting.

Select Relevant Investigations
Full Blood Count

Performed

WBC: 14×103/mm3
Neutrophils: 70%
Lymphocytes: 25%
Hb: 12.8 g/dL
Platelets: 58,000/mm3
Urine Full Report

Performed

Color: yellow
Turbid
Urinary protein: +
Urinary glucose: none
Pus Cells: 25-30/hpf
Red Cells: 60-70/hpf
Epithelial Cells: occasional
Hyaline and granular casts: +
Organisms: none
Liver Profile + CPK

Performed

Total bilirubin: 4.3 mg/dL (<1.2)
Direct bilirubin: 2.6 mg/dL (<0.2)
ALP: 163 U/L (30-130)
AST: 141 U/L (10-45)
ALT: 180 U/L (10-45)
CPK: 854 U/L (20-260)
Leptospira Dipstick Assay

Performed

The dipstick assay is positive.

Select Relevant Management
Acetaminophen
Oral Doxycycline
IV Penicillin
Lamivudine