A Rare Case of Weil's Syndrome With Extreme Hyperbilirubinemia in an Urban Setting.

We present a unique case of Weil's disease, a severe form of leptospirosis caused by Leptospira interrogans, a rare agent seen in both temperate and tropical climates but is more commonly seen in tropical climates and transmitted to humans commonly by rodent urine contamination. It is an under-reported infection, with 1.03 million cases documented annually, and is not commonly found in the United States. A 32-year-old African American male presented with abdominal pain and pressure in his chest associated with nausea, vomiting, and diarrhea. On exam, scleral icterus, sublingual jaundice, and hepatosplenomegaly were noted. Imaging studies revealed the patient had incidental situs inversus and dextrocardia. Labs revealed leukocytosis, thrombocytopenia, transaminitis, and significant direct hyperbilirubinemia of over 30 mg/dL. An extensive workup revealed the patient had leptospirosis due to rat contamination in his apartment. The patient was treated with doxycycline, and his clinical status improved. The heterogeneous and unique clinical presentation of leptospirosis gives rise to a broad differential diagnosis. We aim to encourage physicians who encounter similar presentations in similar urban settings in the United States to include leptospirosis in their differential.