A 57-year-old man presented with fever accompanied by arthralgia, headache and severe myalgia in his legs. He developed loose stools, cough, dyspnea, and oliguria in the last two days. His medical history included epilepsy and he was being treated with topiramate and sodium valproate.
Due to the occasional sightings of mice in his shop, doctors suspected leptospirosis. Physical examination Temperature: 39.5 o C Dyspnea Mild dehydration Flushed skin Mild ankle edema Pulse rate: 110/minute Blood pressure: 160/100 mmHg Respiratory rate: 24/minute Jugular venous pressure: Elevated Bilateral fine crepitations were observed in both lung fields Oxygen saturation: 90% Laboratory examination Leukocyte count: 20.04 × 10 9 /l (91% neutrophils) Platelet count: 116 × 10 9 /l CRP: 208.6 mg/dl Blood and urine cultures: Negative ECG-normal Troponin I titre: 0.16 ng/ml (<0.12 ng/ml) ALT level: 92.2 U/l…
