Abstract
Background Leptospirosis is a zoonotic bacterial disease that can present in a highly variable way, complicating diagnosis. It is caused by the Leptospira species and sources of infection include contact with animals or with soil and water contaminated by animals. In New Zealand, it is the most common infectious disease caught in the workplace.
Case Presentation The patient was a 32 year-old lady, seven months postpartum, who presented with two weeks of persistent left-sided headache and some episodes of stuttering speech. She was admitted with a concern of venous sinus thrombosis, but CT venogram and CT head with contrast were unremarkable. With no focal neurology on examination, she was discharged the following day, but represented within 24h with fevers and a focal to generalised onset tonic-clonic seizure. CSF was consistent with aseptic meningitis. MRI showed subtle left meningeal enhancement. She was commenced initially on broad-spectrum treatment for meningoencephalitis, rationalised to antivirals after a negative PCR. With ongoing fevers, leptospirosis urinary PCR was tested and found to be positive.
Conclusion Meningitis associated with Leptospira infection has been well described, but may be underrecognised in the absence of other clinical signs. Due to the biphasic nature of the disease, the diagnosis can be challenging to make. This case demonstrates the importance of considering leptospirosis as a differential diagnosis for aseptic meningitis.
