Friday, August 21, 2009

Three Blind Mice

Isn't this the most wicked picture ever? The patient has a subconjunctival hemorrhage and weirdly disconjugate eyes but the pathognomonic finding is in the right eye conjunctiva, upper palpebral border.

This guy traveled in the tropics. Or Hawaii, which sees the highest number of cases in the U.S. Despite the title of this case, he's not blind, but he did run into rats. Lots of them.

Clinically, he presented with abrupt onset fever, rigors, myalgias, headache, nausea, vomiting, diarrhea. The eyes are the only abnormal physical exam finding. Laboratory values show WBC 8,000 with left shift, U/A with pyuria, proteinuria, and granular casts, elevated CK, and hyponatremia.

The organism is shown 200x dark-field microscope below. It can be grown in culture, but only on special media.

Challenge: What's your diagnosis?

First image shown under fair use, second image is in the public domain.


shabnam said...

Leptospirosis a.k.a Weil's disease...nice touch,the eyes !

Alex said...


Craig Chen said...

wow! nicely done - this was a tough case!
Three Blind Mice

The eye finding shown is conjunctival suffusion and the disease described is leptospirosis, a zoonotic infection due to the spirochete Leptospira interrogans. The disease is also called Weil's disease, Swineherd diseaes, rice-field fever, cane-cutter fever, swamp fever, mud fever, hemorrhagic jaundice, Stuttgart disease, and Canicola fever. Infected animals include rodents, cattle, swine, dogs, horses, sheep, and goats; transmission is by urine.

Sources: UpToDate; Goldman: Cecil Medicine, 23rd ed., image courtesy of Antonio Seguro and Paulo Marotto; Wikipedia.