Weil’s disease or acute liver failure? Look in the eyes!

A 30-year-old female presented with a 1-week history of headache, jaundice, and an acute-onset one-day history of encephalopathy. Laboratory investigations showed hyperbilirubinemia, transaminitis, and a prothrombin time of 67.4 s (control value: 13 s). The patient was intubated and managed in the intensive care unit. The acute onset of the symptoms, together with the laboratory findings, pointed to a diagnosis of acute liver failure. However, careful examination of the patient revealed the presence of left conjunctival suffusion (Fig. 1). This, suggesting leptospirosis, raised a diagnostic dilemma. The diagnosis of leptospirosis was subsequently confirmed by ELISA IGM.

Fig. 1

A: Icterus, B: conjunctival suffusion

The main features differentiating Weil’s disease from acute liver failure are: raised CPK levels, the presence of conjunctival suffusion, and less severe transaminitis.

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Correspondence to Sonu Sama.

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Sama, S., Agarwal, A., Ramakumar, N. et al. Weil’s disease or acute liver failure? Look in the eyes!. Intensive Care Med 46, 125 (2020) doi:10.1007/s00134-019-05764-1

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