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.
WBC: 14×103/mm3 Neutrophils: 70% Lymphocytes: 25% Hb: 12.8 g/dL Platelets: 58,000/mm3
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
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)
The dipstick assay is positive.