A 40-year-old rice farmer in Thailand presents with fever, muscle pain, jaundice, and oliguria. He was working barefoot in flooded fields. Examination reveals conjunctival suffusion, hepatomegaly, and tender calves. Differential Diagnosis: Leptospirosis Malaria Hepatitis A/E Yellow fever Initial Investigations: Leptospira IgM or PCR → Positive. CBC → Leukocytosis, thrombocytopenia. Liver function tests → Elevated bilirubin, AST/ALT. Renal function tests → Acute kidney injury (elevated creatinine). Management Approach: IV Penicillin G or Doxycycline. IV fluids for AKI. Monitor urine output and correct electrolyte imbalances. Learning Points: Leptospirosis ("Weil’s disease") is common in farmers exposed to contaminated water. Conjunctival suffusion is a key clinical clue. Can cause multi-organ failure, needing early antibiotics.
