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Pancreatitis and myocarditis followed by pulmonary hemorrhage, a rare presentation of leptospirosis- a case report and literature survey.
BMC Infect Dis. 2013 Jan 24; 13:38.BI

Abstract

BACKGROUND

Leptospirosis is a potentially fatal disease which can cause multi-organ dysfunction. It can rarely present as acute pancreatitis. This is the first ever report of leptospirosis presenting with acute pancreatitis and myocarditis followed by diffuse pulmonary hemorrhages to the best of our knowledge.

CASE PRESENTATION

A 15-year-old South Asian boy presented with high grade fever, epigastric discomfort and was anicteric on admission. He developed tachycardia, transient hypotension, changes of electro-cardiogram and positive troponin I suggestive of myocarditis. Acute pancreatitis was diagnosed with 12 fold high serum amylase and with the evidence of computerized tomography. Then he developed diffuse pulmonary hemorrhages and later acute renal failure. Leptospirosis was confirmed by positive leptospira IgM, negative IgG and strongly positive Microscopic Agglutination Test. Other possible infective and autoimmune causes were excluded. Patient recovered completely with antibiotics and the supportive care.

CONCLUSION

This case illustrates diagnostic difficulties especially in resource poor settings where leptospirosis is common. Additionally it highlights the fact that leptospirosis should be considered in patients presenting with pancreatitis which can be complicated with myocarditis and diffuse pulmonary hemorrhages. We hypothesize that Toll like receptors may play a role in such systemic involvement.

Authors+Show Affiliations

University Medical Unit, National Hospital of Sri Lanka, Colombo, 10, 01000, Sri Lanka. nuwan.rk@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

23347428

Citation

Ranawaka, Nuwan, et al. "Pancreatitis and Myocarditis Followed By Pulmonary Hemorrhage, a Rare Presentation of Leptospirosis- a Case Report and Literature Survey." BMC Infectious Diseases, vol. 13, 2013, p. 38.
Ranawaka N, Jeevagan V, Karunanayake P, et al. Pancreatitis and myocarditis followed by pulmonary hemorrhage, a rare presentation of leptospirosis- a case report and literature survey. BMC Infect Dis. 2013;13:38.
Ranawaka, N., Jeevagan, V., Karunanayake, P., & Jayasinghe, S. (2013). Pancreatitis and myocarditis followed by pulmonary hemorrhage, a rare presentation of leptospirosis- a case report and literature survey. BMC Infectious Diseases, 13, 38. https://doi.org/10.1186/1471-2334-13-38
Ranawaka N, et al. Pancreatitis and Myocarditis Followed By Pulmonary Hemorrhage, a Rare Presentation of Leptospirosis- a Case Report and Literature Survey. BMC Infect Dis. 2013 Jan 24;13:38. PubMed PMID: 23347428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pancreatitis and myocarditis followed by pulmonary hemorrhage, a rare presentation of leptospirosis- a case report and literature survey. AU - Ranawaka,Nuwan, AU - Jeevagan,Vijayabala, AU - Karunanayake,Panduka, AU - Jayasinghe,Saroj, Y1 - 2013/01/24/ PY - 2012/08/11/received PY - 2013/01/23/accepted PY - 2013/1/26/entrez PY - 2013/1/26/pubmed PY - 2013/6/19/medline SP - 38 EP - 38 JF - BMC infectious diseases JO - BMC Infect Dis VL - 13 N2 - BACKGROUND: Leptospirosis is a potentially fatal disease which can cause multi-organ dysfunction. It can rarely present as acute pancreatitis. This is the first ever report of leptospirosis presenting with acute pancreatitis and myocarditis followed by diffuse pulmonary hemorrhages to the best of our knowledge. CASE PRESENTATION: A 15-year-old South Asian boy presented with high grade fever, epigastric discomfort and was anicteric on admission. He developed tachycardia, transient hypotension, changes of electro-cardiogram and positive troponin I suggestive of myocarditis. Acute pancreatitis was diagnosed with 12 fold high serum amylase and with the evidence of computerized tomography. Then he developed diffuse pulmonary hemorrhages and later acute renal failure. Leptospirosis was confirmed by positive leptospira IgM, negative IgG and strongly positive Microscopic Agglutination Test. Other possible infective and autoimmune causes were excluded. Patient recovered completely with antibiotics and the supportive care. CONCLUSION: This case illustrates diagnostic difficulties especially in resource poor settings where leptospirosis is common. Additionally it highlights the fact that leptospirosis should be considered in patients presenting with pancreatitis which can be complicated with myocarditis and diffuse pulmonary hemorrhages. We hypothesize that Toll like receptors may play a role in such systemic involvement. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/23347428/Pancreatitis_and_myocarditis_followed_by_pulmonary_hemorrhage_a_rare_presentation_of_leptospirosis__a_case_report_and_literature_survey_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-13-38 DB - PRIME DP - Unbound Medicine ER -