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Step 1: View clinicals

A 49 year old man presents with intermittent fever, a generalized headache and myalgia particularly prominent in both calves, for 7 days. He also noticed yellowish discoloration of both eyes for the last 2 days. Further inquiry reveals the passage of dark colored urine for approximately the same duration. His medical and surgical histories are unremarkable. He does not smoke or consume alcohol. He travelled to Sri Lanka 1 week ago, where he engaged in trekking and white water rafting.

Step 2: Order all relevant investigations

Full Blood Count

WBC: 14×103/mm3 Neutrophils: 70% Lymphocytes: 25% Hb: 12.8 g/dL Platelets: 58,000/mm3

Urine Full Report

Color: yellow Turbid Urinary protein: + Urinary glucose: none Pus Cells: 25-30/hpf Red Cells: 60-70/hpf Epithelial Cells: occasional Hyaline and granular casts: + Organisms: none

Liver Profile + CPK

Total bilirubin: 4.3 mg/dL (<1.2) Direct bilirubin: 2.6 mg/dL (<0.2) ALP: 163 U/L (30-130) AST: 141 U/L (10-45) ALT: 180 U/L (10-45) CPK: 854 U/L (20-260)

Leptospira Dipstick Assay

The dipstick assay is positive.

Step 3: Select appropriate management

Oral Doxycycline
IV Penicillin

Score: ★★☆