Rarely, leptospirosis may cause an autoimmune condition known as Weil disease. It occurs after the bacteria have been cleared from the circulation during a period of bacteremia, but antibody-mediated mechanisms continue to have an effect on the patient's internal organs. Symptoms often manifest as acute kidney damage and high-grade hyperbilirubinemia, weeks after exposure. In severe cases of chronic Weil disease, treatment with antibiotics, plasmapheresis, hemodialysis, and glucocorticosteroid therapy may be required to speed the patient's recovery.