Letter to the Editor - Intracranial Bleeding in Weil's Disease

Sir,
A 45-year-old male presented with history of fever, generalised myalgia and high coloured urine of one week's duration. He developed obtundation with generalised tonic-clonic seizures on the previous day of admission. There was no history of any significant medical illness in the past. He was drowsy, icteric, with bilateral subconjunctival haemorrhages and conjunctival congestion. Blood pressure was 140/84 mm Hg. There was anisocoria with the left pupil being larger, bilateral brisk deep tendon reflexes and bilateral extensor plantar responses. There were no signs of meningeal irritation and the ocular fundi were normal. He had hepatomegaly of 2 cms and mild ascites. There was no evidence of haematuria or bleeding from intravenous access sites. The total leucocyte count was 11,500/mm³ with 75% polymorphs, ESR 100mm/h, serum bilirubin 8.1mg/dL, blood urea 193mg/dL and creatinine 7.3mg/dL with a normal platelet count and liver enzymes. Weil's IgM antibody by ELISA was > 20 panbio units. Prothrombin time (13, control 12 seconds) and activated partial thromboplastin time (32, control 30 seconds) were normal. FDP was <10. CT scan head showed intracerebral haematoma in the right deep parietal lobe with intraventricular, subarachnoid, subdural and extradural haematomas and midline shift. The patient succumbed, 9 hours after admission despite treatment with crystalline penicillin, anti-oedema measures and platelet transfusion.