title: Leptospirosis presenting in a woman with fulminant hepatic failure from Wilson's disease: a case report.
abstract: BACKGROUND
  We report an unusual case of Wilson's disease that was revealed by presentation of leptospirosis. The prompt detection of this potentially life-threatening disease highlights the importance of careful investigation. To the best of our knowledge, this is the first reported case of leptospirosis involving the development of fulminant liver failure due to Wilson's disease.
  
  
  METHODS
  A 17-year-old Caucasian woman presented with fever, rigors, vomiting and scleral jaundice. Following clinical and laboratory evaluation she was diagnosed with leptospirosis. After remission of this disease her condition inexplicably deteriorated. Further investigations revealed that she had Wilson's disease.
  
  
  CONCLUSIONS
  The unexplained deterioration of hepatic function in a young person in remission from leptospirosis should alert the clinician to the presence of an underlying disorder, such as Wilson's disease, the early detection of which is crucial to the prognosis. The mechanism that initiates the development of Wilson's disease is not fully understood, but it is thought that an intercurrent illness, such as viral infection or drug toxicity, could be implicated. In our case, leptospirosis appeared to precipitate the deterioration of liver function in a patient with Wilson's disease, advancing our knowledge of this association. This original case report could have a broader clinical impact across medicine.
authors.affiliation: 3rd Department of Internal Medicine "Evangelismos" State General Hospital, Athens, Greece. andreadise@ath.forthnet.gr.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Andreadis
authors.forename: Gerasimos D
authors.initials: GD
authors.lastname: Agaliotis
authors.forename: George P
authors.initials: GP
authors.lastname: Mousoulis