{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:10:04Z","timestamp":1756318204467,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,7,15]]},"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:p>A man in his 50s presents with a short history of rigors, back pain and dark urine. This was associated with scleral icterus. He was initially treated as urosepsis due to perinephric fat stranding on his first CT but continued to deteriorate with worsening sepsis requiring intensive care admission. He had a conjugated hyperbilirubinaemia (peak 708\u2009\u00b5mol\/L) with normal liver enzymes, anaemia, thrombocytopaenia, acute kidney injury requiring filtration and respiratory failure requiring ventilatory support. A subsequent CT revealed mediastinal lymphadenopathy and extensive ground-glass changes with patchy consolidation. When his history was revisited, exposure to rodents was identified, and serological testing for leptospirosis subsequently came back positive. This case explores the causes of hyperbilirubinaemia in leptospirosis, the dangers of tunnel vision in diagnostic medicine and the importance of prompt antibiotic therapy in Weil\u2019s disease.<\/jats:p>","DOI":"10.1136\/bcr-2024-261771","type":"journal-article","created":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T22:41:14Z","timestamp":1722379274000},"page":"e261771","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Weil\u2019s disease in a temperate climate: diagnostic uncertainty and the importance of prompt antibiotic treatment"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9485-5576","authenticated-orcid":false,"given":"Jamie","family":"Arberry","sequence":"first","affiliation":[{"name":"Acute Medicine, Epsom and Saint Helier Hospital NHS Trust, Carshalton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Williams","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Epsom and Saint Helier Hospital NHS Trust, Carshalton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madiha","family":"Abbas","sequence":"additional","affiliation":[{"name":"Intensive Care Medicine, Epsom and Saint Helier Hospital NHS Trust, Carshalton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,7,30]]},"reference":[{"key":"2025082710305070000_17.7.e261771.1","unstructured":"UK Health Security Agency . Common-associated infections (England): fourth quarter 2023. 2024. Available: https:\/\/www.gov.uk\/government\/publications\/common-animal-associated-infections-2023\/common-animal-associated-infections-england-fourth-quarter-2023#leptospirosis"},{"key":"2025082710305070000_17.7.e261771.2","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcs145"},{"key":"2025082710305070000_17.7.e261771.3","first-page":"5876718","article-title":"The spiraling case of a yellow chef: isolated hyperbilirubinemia","volume":"2018","author":"Jiang","year":"2018","journal-title":"Case Rep Hepatol"},{"key":"2025082710305070000_17.7.e261771.4","article-title":"Weil\u2019s disease: a rare cause of jaundice","volume":"12","author":"Satiya","year":"2020","journal-title":"Cureus"},{"key":"2025082710305070000_17.7.e261771.5","first-page":"5189542","article-title":"Liver transplantation for acute liver failure attributed to leptospirosis: a report of two cases","volume":"2019","author":"Lebreton","year":"2019","journal-title":"Case Rep Crit Care"},{"key":"2025082710305070000_17.7.e261771.6","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1016\/j.prp.2014.05.002","article-title":"Weil\u2019s disease (leptospirosis) manifesting as fulminant hepatic failure: report of an autopsy case","volume":"210","author":"Shintaku","year":"2014","journal-title":"Pathol Res Pract"},{"key":"2025082710305070000_17.7.e261771.7","unstructured":"World Health Organisation . Human leptospirosis: guidance for diagnosis, surveillance and control International Leptospirosis Society\/World Health Organization. 2023. Available: https:\/\/www.who.int\/publications\/i\/item\/human-leptospirosis-guidance-for-diagnosis-surveillance-and-control"},{"key":"2025082710305070000_17.7.e261771.8","unstructured":"Centre for Disease Control and Prevention . Leptospirosis: fact sheet for clinicians. 2018. Available: https:\/\/www.cdc.gov\/leptospirosis\/pdf\/fs-leptospirosis-clinicians-eng-508.pdf"},{"key":"2025082710305070000_17.7.e261771.9","doi-asserted-by":"publisher","DOI":"10.1093\/trstmh\/tru148"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-261771","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:30:59Z","timestamp":1756315859000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-261771"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":9,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7,30]]},"published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1136\/bcr-2024-261771"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-261771","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,7]]}}}