{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T07:16:25Z","timestamp":1793862985649,"version":"4.6.1"},"reference-count":28,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,6,17]]},"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:p>A healthy, urban-dwelling man presented with lassitude, jaundice without increased liver enzymes or obstructive features on imaging, brief acute kidney injury, leucocytosis with near-normal C reactive protein and markedly increased serum amylase and lipase. Leptospirosis was not considered for 10 days because of the low incidence of the disease in the country, absent animal contact and physicians\u2019 low index of suspicion. Presentation without fever and without the commonly associated abdominal pain, myalgia, headache, thrombocytopaenia or elevated serum creatine kinase added to the diagnostic challenge. Once an infectious cause of acute pancreatitis was contemplated, leptospirosis was immediately sought and diagnosed by PCR of urine and microscopic agglutination test, and he fully recovered on ceftriaxone. Physicians in countries with a low incidence of leptospirosis should be more aware of the possibility of the disease even when several key features such as fever or pain are missing and the patient has a rare infectious acute pancreatitis.<\/jats:p>","DOI":"10.1136\/bcr-2020-234988","type":"journal-article","created":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T03:20:18Z","timestamp":1598325618000},"page":"e234988","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Acute painless pancreatitis as an unusual presentation of leptospirosis in a low-incidence country"],"prefix":"10.1136","volume":"13","author":[{"given":"Ami","family":"Schattner","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel"},{"name":"Laniado Hospital, Sanz Medical Centre, Netanya, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ina","family":"Dubin","sequence":"additional","affiliation":[{"name":"Laniado Hospital, Sanz Medical Centre, Netanya, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yair","family":"Glick","sequence":"additional","affiliation":[{"name":"Laniado Hospital, Sanz Medical Centre, Netanya, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Nissim","sequence":"additional","affiliation":[{"name":"Laniado Hospital, Sanz Medical Centre, Netanya, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,8,24]]},"reference":[{"key":"2025082708114648000_13.8.e234988.1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.14.2.296-326.2001"},{"key":"2025082708114648000_13.8.e234988.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-4679(98)00097-3"},{"key":"2025082708114648000_13.8.e234988.3","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcs145"},{"key":"2025082708114648000_13.8.e234988.4","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1097\/MAJ.0b013e3182787068","article-title":"Leptospirosis in New Orleans","volume":"347","author":"Toliver","year":"2014","journal-title":"Am J Med Sci"},{"key":"2025082708114648000_13.8.e234988.5","doi-asserted-by":"publisher","DOI":"10.4103\/2321-3868.132689"},{"key":"2025082708114648000_13.8.e234988.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2008.03157.x"},{"key":"2025082708114648000_13.8.e234988.7","doi-asserted-by":"crossref","first-page":"177","DOI":"10.5414\/CN108324","article-title":"Acute kidney injury and hyperbilirubinemia in a young male after ingestion of Tribulus terrestris","volume":"83 (2015","author":"Ryan","year":"2015","journal-title":"Clin Nephrol"},{"key":"2025082708114648000_13.8.e234988.8","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2013.78"},{"key":"2025082708114648000_13.8.e234988.9","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/SHK.0b013e31828fae49","article-title":"Pathophysiology of leptospirosis","volume":"39","author":"Seguro","year":"2013","journal-title":"Shock"},{"key":"2025082708114648000_13.8.e234988.10","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1128\/jcm.30.9.2219-2224.1992","article-title":"Polymerase chain reaction for detection of Leptospira spp. in clinical samples","volume":"30","author":"M\u00e9rien","year":"1992","journal-title":"J Clin Microbiol"},{"key":"2025082708114648000_13.8.e234988.11","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.jiac.2014.09.002","article-title":"Short-Course treatment with ceftriaxone for leptospirosis: a retrospective study in a single center in eastern France","volume":"21","author":"Faucher","year":"2015","journal-title":"J Infect Chemother"},{"key":"2025082708114648000_13.8.e234988.12","doi-asserted-by":"crossref","DOI":"10.1016\/j.actatropica.2019.105183","article-title":"Leptospirosis: increasing importance in developing countries","volume":"201","author":"ZMP","year":"2020","journal-title":"Acta Tropica"},{"key":"2025082708114648000_13.8.e234988.13","unstructured":"Ministry of Health, Israel . 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