Co-infection With Leptospirosis During Acute Hepatitis B Serologic Recovery: A Case Report.

Leptospirosis is a zoonotic infection that can cause acute liver injury and mimic viral hepatitis. We report a 30-year-old woman presenting with myalgia, progressive jaundice, and markedly elevated aminotransferases, initially diagnosed with acute hepatitis B. She reported regular contact with her dog. Despite serologic recovery with hepatitis B surface antigen seroconversion, severe hyperbilirubinemia and coagulopathy were atypical for resolving hepatitis B. Further evaluation revealed positive Leptospira immunoglobulin M (IgM) serology, and leptospirosis was diagnosed using modified Faine's criteria. Treatment with meropenem resulted in rapid clinical and biochemical improvement, highlighting leptospirosis as an important hidden cause of acute liver injury.