Fulminant Postpartum Weil's Syndrome Presenting with Refractory Seizures and Multiorgan Failure: A Case Report and Critical Care Management.

Leptospirosis is a globally prevalent zoonotic infection with protean manifestations, while severe disease (Weil's syndrome) is uncommon and rarely reported in the postpartum period, where it can closely mimic obstetric emergencies. We report a rare case of severe postpartum leptospirosis complicated by sudden-onset seizures and multiorgan failure. A 32-year-old woman developed generalized tonic-clonic seizures two hours after vaginal delivery, followed by septic shock, hyperpyrexia, refractory seizures, acute liver failure, acute kidney injury, coagulopathy, and stress-induced cardiomyopathy. Initial differentials included obstetric catastrophes such as eclampsia, acute fatty liver of pregnancy, and amniotic fluid embolism. Diagnosis was supported by a positive Leptospira IgM ELISA in the appropriate clinical context; however, confirmatory testing with the microscopic agglutination test (MAT) or polymerase chain reaction (PCR) could not be performed, which remains a limitation of this report. Magnetic resonance imaging (MRI) of the brain revealed features of cerebral hyperperfusion, a finding not previously reported in postpartum Weil's disease. Prompt institution of targeted antimicrobial therapy, aggressive critical care support, and multimodal monitoring resulted in gradual recovery. Cerebral oxygenation and response to therapy were continuously monitored using bilateral near-infrared spectroscopy (NIRS), representing a novel neuromonitoring strategy in this setting. This case highlights leptospirosis as an important differential in postpartum seizures with multiorgan failure in endemic regions. It expands the spectrum of postpartum Weil's disease by demonstrating cerebral hyperperfusion on MRI, novel use of NIRS monitoring, and associated stress-induced cardiomyopathy, with important implications for critical care management.