Acute kidney injury, pancreatitis, and hepatitis associated with leptospirosis in a 4-year-old domestic dog in Entre Ríos, Argentina

Abstract

Leptospirosis is a zoonosis of global impact that in dogs, it typically presents as a multisystemic syndrome characterized by acute kidney injury (AKI) and hepatic dysfunction. Although endothelial damage and systemic inflammatory response can affect non-target organs, pancreatic involvement remains underdiagnosed in small animal practice. The objective of this report is to describe the diagnosis and favorable clinical outcome of an uncommon case of severe AKI combined with pancreatitis and hepatitis secondary to leptospirosis in a dog. A 4-year-old male Jack Russell Terrier crossbreed, unvaccinated against leptospirosis, was presented with anorexia, vomiting, abdominal pain, and anuria. Initial laboratory findings revealed severe azotemia (creatinine: 6.48 mg/dL, urea: 206 mg/dL) with normal liver enzymes. Abdominal ultrasonography demonstrated acute pancreatitis (pancreatic hypoechogenicity and peripancreatic fluid) and renal involvement with elevated arterial resistance index. Following fluid therapy, multimodal analgesia, and penicillin-streptomycin administration, azotemia resolved within 72 hours. However, a delayed elevation of hepatobiliary enzymes and direct bilirubin was observed during the convalescent phase, demonstrating an asynchronous kinetic response. The microscopic agglutination tube test (MAT) confirmed a fourfold seroconversion for Leptospira borgpetersenii (serovar Castellonis) and L. interrogans (serovar Canicola), reaching titers of 1:3200. Following doxycycline completion and long-term renal protection, the patient remains asymptomatic two years post-recovery. This case highlights the necessity of considering leptospirosis in the differential diagnosis of acute abdomen with pancreatic involvement and underscores the critical role of serial ultrasonography and comprehensive biochemical monitoring.