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Co-existent facial palsy and myocarditis in a 50-year old farmer diagnosed with probable leptospirosis: a case report.
BMC Res Notes. 2015 Feb 04; 8:26.BR

Abstract

BACKGROUND

Leptospirosis is a worldwide zoonotic disease caused by spirochetes belonging to the genus Leptospira. This is a case report on a patient with probable leptospirosis, who developed lower motor neuron facial nerve palsy during the recovery phase of this illness. Leptospirosis is endemic in Sri Lanka and this complication has been reported earlier in other countries but not in Sri Lanka to the best of our knowledge.

CASE PRESENTATION

A previously well 50 year old Sinhalese farmer in Sri Lanka was admitted to a tertiary care hospital with five day history of fever, headache, prostration, severe myalgia especially in the calves and yellowish discoloration of the eyes. He was febrile, icteric and had suffusion of both conjunctivae. His pulse rate and blood pressure was 98/min and 90/50 mmHg respectively. The initial laboratory examinations showed neutrophil leukocytosis and thrombocytopenia. Antibodies test for leptospirosis was done and IgM was positive. Because of this evidence the probable diagnosis of leptospirosis was made and antibiotic therapy initialed with intravenous cefotaxime 1 g 8 hourly and crystalline penicillin 2 mu 6 hourly. On the eighth day he developed chest pain associated with shortness of breath with a heart rate of 120/min. Electrocardiographic and echocardiographic evidence suggested myocarditis, and troponin I titer was positive. Supportive care was provided and antibiotics were continued. On the 13(th) day of illness he developed lower motor type facial nerve palsy of the left side with positive Bell's phenomenon. But rest of the neurological examination was normal. He was discharged on a step-down course of prednisolone and physiotherapy. He fully recovered from cardiac involvement before discharge but recovery from facial nerve palsy took place only six months later.

CONCLUSION

Our case emphasizes cardiac and facial nerve involvement in leptospirosis. This is the first published report in Sri Lanka of facial nerve palsy occurring in leptospirosis possibly due to immunological damage. Further literature survey revealed that this is the first case in the world with simultaneous occurrence of myocarditis and facial nerve palsy in leptospirosis. The pathogenesis of this occurrence is yet to be fully understood.

Authors+Show Affiliations

University Medical Unit, Teaching Hospital, Peradeniya, Sri Lanka. prabhashinikumarihamy@yahoo.com.Department of Medicine, University of Peradeniiya, Peradeniiya, Sri Lanka. udayapralapanawa@yahoo.com.Department of Medicine, University of Peradeniiya, Peradeniiya, Sri Lanka. thilakj@gmail.com.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25648561

Citation

Kumarihamy, Kulatunga Wijekoon Mudiyanselage Pramitha Prabhashini, et al. "Co-existent Facial Palsy and Myocarditis in a 50-year Old Farmer Diagnosed With Probable Leptospirosis: a Case Report." BMC Research Notes, vol. 8, 2015, p. 26.
Kumarihamy KW, Ralapanawa DM, Jayalath WA. Co-existent facial palsy and myocarditis in a 50-year old farmer diagnosed with probable leptospirosis: a case report. BMC Res Notes. 2015;8:26.
Kumarihamy, K. W., Ralapanawa, D. M., & Jayalath, W. A. (2015). Co-existent facial palsy and myocarditis in a 50-year old farmer diagnosed with probable leptospirosis: a case report. BMC Research Notes, 8, 26. https://doi.org/10.1186/s13104-015-0992-4
Kumarihamy KW, Ralapanawa DM, Jayalath WA. Co-existent Facial Palsy and Myocarditis in a 50-year Old Farmer Diagnosed With Probable Leptospirosis: a Case Report. BMC Res Notes. 2015 Feb 4;8:26. PubMed PMID: 25648561.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Co-existent facial palsy and myocarditis in a 50-year old farmer diagnosed with probable leptospirosis: a case report. AU - Kumarihamy,Kulatunga Wijekoon Mudiyanselage Pramitha Prabhashini, AU - Ralapanawa,Dissanayake Mudiyanselage Priyantha Udaya Kumara, AU - Jayalath,Widana Arachchilage Thilak Ananda, Y1 - 2015/02/04/ PY - 2014/08/13/received PY - 2015/01/23/accepted PY - 2015/2/5/entrez PY - 2015/2/5/pubmed PY - 2015/12/15/medline SP - 26 EP - 26 JF - BMC research notes JO - BMC Res Notes VL - 8 N2 - BACKGROUND: Leptospirosis is a worldwide zoonotic disease caused by spirochetes belonging to the genus Leptospira. This is a case report on a patient with probable leptospirosis, who developed lower motor neuron facial nerve palsy during the recovery phase of this illness. Leptospirosis is endemic in Sri Lanka and this complication has been reported earlier in other countries but not in Sri Lanka to the best of our knowledge. CASE PRESENTATION: A previously well 50 year old Sinhalese farmer in Sri Lanka was admitted to a tertiary care hospital with five day history of fever, headache, prostration, severe myalgia especially in the calves and yellowish discoloration of the eyes. He was febrile, icteric and had suffusion of both conjunctivae. His pulse rate and blood pressure was 98/min and 90/50 mmHg respectively. The initial laboratory examinations showed neutrophil leukocytosis and thrombocytopenia. Antibodies test for leptospirosis was done and IgM was positive. Because of this evidence the probable diagnosis of leptospirosis was made and antibiotic therapy initialed with intravenous cefotaxime 1 g 8 hourly and crystalline penicillin 2 mu 6 hourly. On the eighth day he developed chest pain associated with shortness of breath with a heart rate of 120/min. Electrocardiographic and echocardiographic evidence suggested myocarditis, and troponin I titer was positive. Supportive care was provided and antibiotics were continued. On the 13(th) day of illness he developed lower motor type facial nerve palsy of the left side with positive Bell's phenomenon. But rest of the neurological examination was normal. He was discharged on a step-down course of prednisolone and physiotherapy. He fully recovered from cardiac involvement before discharge but recovery from facial nerve palsy took place only six months later. CONCLUSION: Our case emphasizes cardiac and facial nerve involvement in leptospirosis. This is the first published report in Sri Lanka of facial nerve palsy occurring in leptospirosis possibly due to immunological damage. Further literature survey revealed that this is the first case in the world with simultaneous occurrence of myocarditis and facial nerve palsy in leptospirosis. The pathogenesis of this occurrence is yet to be fully understood. SN - 1756-0500 UR - https://www.unboundmedicine.com/medline/citation/25648561/Co_existent_facial_palsy_and_myocarditis_in_a_50_year_old_farmer_diagnosed_with_probable_leptospirosis:_a_case_report_ L2 - https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-015-0992-4 DB - PRIME DP - Unbound Medicine ER -