{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T04:51:08Z","timestamp":1784868668195,"version":"3.55.0"},"reference-count":10,"publisher":"SMC Media","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction:\u00a0Leptospirosis is a common zoonotic infection in tropical regions with diverse clinical manifestations. Fever occurs in 89\u2013100% of cases, while afebrile cases are extremely rare and seldom reported in the literature, accounting for less 1% of severe leptospirosis cases, posing a diagnostic challenge in clinical practice. Case description:\u00a0we report on a 43-year-old male farmer from northern Vietnam who was admitted with rapidly progressive jaundice and severe acute kidney injury following exposure to contaminated paddy field water. Notably, the patient remained afebrile throughout the disease course \u2013 an atypical presentation rarely seen in severe leptospirosis. The incubation period was extremely short (one day) with rapid progression to multi-organ failure within three days. Diagnosis was confirmed serologically with Leptospira IgM &gt;100 U\/ml and a more than 4-fold increase in IgG titre (from 10.4 to 72.3 U\/ml) according to WHO criteria. The SOFA score at admission was 9 points. The patient responded well to combination antibiotic therapy, corticosteroids and renal replacement therapy, achieving complete recovery after 24 days. Conclusion:\u00a0This case emphasises the importance of not excluding leptospirosis even in the absence of fever, particularly in endemic areas with occupational risk factors. Markedly elevated bilirubin disproportionate to AST, ALT and rapidly progressive acute kidney injury are important suggestive signs.<\/jats:p>","DOI":"10.12890\/2025_005762","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T14:33:22Z","timestamp":1758638002000},"source":"Crossref","is-referenced-by-count":1,"title":["Severe leptospirosis with apyrexia and an atypical presentation: rapid progression to multi-organ failure"],"prefix":"10.12890","volume":"12","author":[{"given":"Ngoc Anh","family":"Doi","sequence":"first","affiliation":[{"name":"Hepatitis Department, National Hospital of Tropical Diseases, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Van Thoai","family":"Pham","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viet Nghia","family":"Le","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam; Department of Tropical Medicine, Thanh Hoa Provincial General Hospital, Thanh Hoa, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quoc Phuong","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10397","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"10.12890\/2025_005762_ref1","doi-asserted-by":"crossref","unstructured":"Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global morbidity and mortality of leptospirosis: a systematic review. PLoS Negl Trop Dis 2015;9:e0003898. doi:10.1371\/journal.pntd.0003898","DOI":"10.1371\/journal.pntd.0003898"},{"key":"10.12890\/2025_005762_ref2","doi-asserted-by":"crossref","unstructured":"Van CT, Thuy NT, San NH, Hien TT, Baranton G, Perolat P. Human leptospirosis in the Mekong delta, Viet Nam. Trans R Soc Trop Med Hyg 1998;92:625\u2013628. doi: 10.1016\/S0035-9203(98)90787-8","DOI":"10.1016\/S0035-9203(98)90787-8"},{"key":"10.12890\/2025_005762_ref3","doi-asserted-by":"crossref","unstructured":"Galdino GS, da Silva Junior GB, De Francesco Daher E. Leptospirosis and Weil\u2019s Syndrome. In: da Silva GB Junior, Daher EF, Barros E, editors. Tropical Nephrology, New York; Springer; 2020, p. 263\u2013276. doi: 10.1007\/978-3-030-44500-3_20","DOI":"10.1007\/978-3-030-44500-3_20"},{"key":"10.12890\/2025_005762_ref4","doi-asserted-by":"crossref","unstructured":"Munoz-Zanzi C, Groene E, Morawski BM, Bonner K, Costa F, Bertherat E, et al. A systematic literature review of leptospirosis outbreaks worldwide, 1970-2012. Rev Panam Salud Publica 2020;44:e78. doi: 10.26633\/RPSP.2020.78","DOI":"10.26633\/RPSP.2020.78"},{"key":"10.12890\/2025_005762_ref5","unstructured":"Wynwood SJ. Advancing Leptospirosis Diagnostics in Human and Animal Systems [thesis]. Queensland, AUS: University of the Sunshine Coast; 2015. doi: 10.25907\/00212"},{"key":"10.12890\/2025_005762_ref6","doi-asserted-by":"crossref","unstructured":"De Brito T, Silva AMGD, Abreu PAE. Pathology and pathogenesis of human leptospirosis: a commented review. Rev Inst Med Trop S\u00e3o Paulo 2018;60:e23. doi: 10.1590\/S1678-9946201860023","DOI":"10.1590\/s1678-9946201860023"},{"key":"10.12890\/2025_005762_ref7","doi-asserted-by":"crossref","unstructured":"Haake DA, Levett PN. Leptospirosis in humans. Curr Top Microbiol Immunol 2015;387:65\u201397.doi: 10.1007\/978-3-662-45059-8_5","DOI":"10.1007\/978-3-662-45059-8_5"},{"key":"10.12890\/2025_005762_ref8","doi-asserted-by":"crossref","unstructured":"Miyahara S, Saito M, Kanemaru T, Villanueva SY, Gloriani NG, Yoshida S. Destruction of the hepatocyte junction by intercellular invasion of Leptospira causes jaundice in a hamster model of Weil\u2019s disease. Int J Exp Pathol 2014;95:271\u2013281. doi: 10.1111\/iep.12085","DOI":"10.1111\/iep.12085"},{"key":"10.12890\/2025_005762_ref9","doi-asserted-by":"crossref","unstructured":"Gamage CD, Tamashiro H, Ohnishi M, Koizumi N. Epidemiology, surveillance and laboratory diagnosis of Leptospirosis in the WHO South-East Asia region. In: Jacob Lorenzo-Morales J, editor. Zoonosis, Intech, 2012, p. 213\u2013226. doi: 10.5772\/37694","DOI":"10.5772\/37694"},{"key":"10.12890\/2025_005762_ref10","unstructured":"Terpstra WJ. Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control. World Health Organization 2003."}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/5762\/4857","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/5762\/4858","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/5762\/4858","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T13:02:52Z","timestamp":1759496572000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/5762"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,23]]},"references-count":10,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.12890\/2025_005762","relation":{"has-manifestation":[{"id-type":"other","id":"1-130-5762-g4857","asserted-by":"subject"},{"id-type":"other","id":"1-130-5762-g4858","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-130","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"value":"2284-2594","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,23]]}}}