case_images: PMC6126086_01
case_images: Multiorgan failure and response to treatments in patient with leptospirosis. (a) Creatinine, total bilirubin, and direct bilirubin levels during and after hospitalization. Shaded green area represents duration of cholestyramine and ursodiol treatment for bile cast nephropathy. (b) White-blood cell count (WBC) and platelet count during and after hospitalization. Shaded grey area represents duration of doxycycline treatment.
case_images: CRIHEP2018-5876718.001.jpg
case_images: PMC6126086_01_CRIHEP2018-5876718.001.jpg
case_images: fig1
case_images: In addition to worsening renal function, he had an impressively rapid rise in his total and direct bilirubin with development of clinical jaundice over the subsequent days with laboratory values on hospital day 8 as follows: Cr of 4, total bilirubin of 41 mg/dL, and direct bilirubin of 38 mg/dL (Figure 1(a)). He was continued on doxycycline 100 mg twice daily with subsequent normalization of leukocyte and platelet counts (Figure 1(b)). The patient completed a 10-day course of doxycycline but unfortunately suffered from bile cast nephropathy from severe hyperbilirubinemia with continued rise in Cr (Figure 1(a)), for which he was treated with cholestyramine and ursodiol.