Question:medium
A 25-year-old sewage worker presents with fever lasting a week, followed by sudden weakness. He has scleral congestion, jaundice, and oliguria. Lab findings show raised bilirubin. What is the most likely diagnosis?
A 25-year-old sewage worker presents with fever lasting a week, followed by sudden weakness. He has scleral congestion, jaundice, and oliguria. Lab findings show raised bilirubin. What is the most likely diagnosis?
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Sewage worker with fever, jaundice, renal failure, and conjunctival suffusion = Weil's disease.
Updated On: May 14, 2026
- Brucellosis
- Weil's disease
- Enteric fever
- DHF
Show Solution
The Correct Option is B
Solution and Explanation
Step 1: Understanding the Question:
The question provides a classic occupational history (sewage worker) and a triad of symptoms: jaundice, renal failure (oliguria), and fever with "scleral congestion."
Step 2: Detailed Explanation:
Leptospirosis: Caused by the spirochete Leptospira interrogans. It is an occupational hazard for those in contact with water or soil contaminated by the urine of infected animals (rats, dogs). Sewage workers and rice field farmers are at high risk.
Biphasic Illness: It typically starts with an acute febrile "septicemic phase" (fever, headache, myalgia, and pathognomonic conjunctival suffusion or scleral congestion).
Weil's Disease (Severe Leptospirosis): This is the icterohemorrhagic form of the disease. It is characterized by:
- Liver involvement: Jaundice with significant hyperbilirubinemia.
- Kidney involvement: Acute kidney injury leading to oliguria or anuria.
- Hemorrhage: Petechiae and bleeding tendencies.
Why not others?
- Brucellosis (A): Causes undulant fever and joint pain, but rarely acute jaundice and renal failure.
- Enteric Fever (C): Presents with step-ladder fever and "pea-soup" stools; conjunctival suffusion is not classic.
- DHF (D): Dengue Hemorrhagic Fever causes high fever and bleeding, but profound jaundice and renal failure as the primary triad suggests Weil's.
Step 3: Final Answer:
The occupational exposure to sewage and the triad of jaundice, oliguria, and conjunctival suffusion is diagnostic of Weil's disease (leptospirosis).
The question provides a classic occupational history (sewage worker) and a triad of symptoms: jaundice, renal failure (oliguria), and fever with "scleral congestion."
Step 2: Detailed Explanation:
Leptospirosis: Caused by the spirochete Leptospira interrogans. It is an occupational hazard for those in contact with water or soil contaminated by the urine of infected animals (rats, dogs). Sewage workers and rice field farmers are at high risk.
Biphasic Illness: It typically starts with an acute febrile "septicemic phase" (fever, headache, myalgia, and pathognomonic conjunctival suffusion or scleral congestion).
Weil's Disease (Severe Leptospirosis): This is the icterohemorrhagic form of the disease. It is characterized by:
- Liver involvement: Jaundice with significant hyperbilirubinemia.
- Kidney involvement: Acute kidney injury leading to oliguria or anuria.
- Hemorrhage: Petechiae and bleeding tendencies.
Why not others?
- Brucellosis (A): Causes undulant fever and joint pain, but rarely acute jaundice and renal failure.
- Enteric Fever (C): Presents with step-ladder fever and "pea-soup" stools; conjunctival suffusion is not classic.
- DHF (D): Dengue Hemorrhagic Fever causes high fever and bleeding, but profound jaundice and renal failure as the primary triad suggests Weil's.
Step 3: Final Answer:
The occupational exposure to sewage and the triad of jaundice, oliguria, and conjunctival suffusion is diagnostic of Weil's disease (leptospirosis).
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