title: Case report: Weil's disease with multiple organ failure in a child living in dengue endemic area.
abstract: BACKGROUND
  There were few reports in the literature of Weil's disease with multiple organ failures, especially in children living in dengue endemic areas.
  
  
  METHODS
  A 12-year-old child was admitted to Tangerang district hospital with a provisional diagnosis of dengue infection. On the third day of hospitalization, dengue diagnostic tests were negative. As fever still remained and was followed by jaundice, decreasing hemoglobin, increasing bilirubin with abnormal value of liver enzymes; other causes of disease were investigated. Leptospirosis was confirmed by rapid IgM test (SD(®)) for leptospira; and micro-agglutination test which indicated Leptospira serogroup bataviae infection. The patient developed Weil's disease during the course of illness. Renal function was back to normal on the 21st day of hospitalization, while hemoglobin and bilirubin returned to normal three weeks after discharged.
  
  
  CONCLUSIONS
  Our report highlights the importance of considering leptospirosis as a differential diagnosis in children with acute febrile illness; even when the signs and symptoms for the more common diagnoses such as dengue or typhoid fever were pathognomonic. A normal leukocyte count with neutrophilia and negative dengue NS1, dengue IgM, and Salmonella typhi IgM on admission should raise suspicion of leptospirosis, and prompt diagnostic assays for leptospirosis should be conducted.
authors.affiliation: Tangerang District Hospital, Tangerang, Indonesia.|Kariadi Hospital, Semarang, Indonesia.
authors.forename: Dewi
authors.initials: D
authors.lastname: Lokida
authors.affiliation: Tangerang District Hospital, Tangerang, Indonesia.
authors.forename: Arif
authors.initials: A
authors.lastname: Budiman
authors.affiliation: Tangerang District Hospital, Tangerang, Indonesia.
authors.forename: Udjiani Edi
authors.initials: UE
authors.lastname: Pawitro
authors.affiliation: Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jakarta, Indonesia.
authors.forename: M Hussein
authors.initials: MH
authors.lastname: Gasem
authors.affiliation: Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jakarta, Indonesia.|National Institute of Health Research and Development (NIHRD), Jakarta, Indonesia.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Karyana
authors.affiliation: Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jakarta, Indonesia. hermaninarespond@gmail.com.
authors.forename: Herman
authors.initials: H
authors.lastname: Kosasih
authors.affiliation: US, National Institute of Allergy and Infectious Disease, Bethesda, USA.
authors.forename: Sophia
authors.initials: S
authors.lastname: Siddiqui
mesh_terms: D002648:Child; D003715:Dengue / Q000097:blood / Q000150:complications*; D019353:Endemic Diseases; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000097:blood / Q000150:complications*; D014895:Weil Disease / Q000097:blood / Q000150:complications*
keywords: Children; Dengue; Leptospirosis; Weil’s disease