A 32-year-old male farmer presents with 6 days of fever, icterus, and oliguria. Bilirubin is 8 mg/dL, ALT is 120 U/L, and serum creatinine is 3.4 mg/dL. On examination he has marked redness of both eyes without purulent discharge. Which single finding most strongly favours leptospirosis over acute viral hepatitis as the cause of his jaundice?

• A Conjunctival suffusion ✓
• B Oliguria
• C High fever at onset of jaundice
• D Raised serum bilirubin out of proportion to transaminases

Explanation

Conjunctival suffusion, a bilateral non-exudative reddening of the eyes, is a hallmark of leptospirosis and is highly suggestive when combined with fever, jaundice, and renal failure. In leptospirosis, serum creatine kinase is typically elevated and transaminases rise modestly, whereas viral hepatitis shows transaminase levels in the thousands with normal creatine kinase. Fever usually subsides with the onset of jaundice in viral hepatitis but persists in Weil disease. Oliguria alone is nonspecific in a febrile dehydrated patient.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.