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Myocarditis causing severe heart failure--an unusual early manifestation of leptospirosis: a case report.
BMC Res Notes. 2015 Mar 13; 8:80.BR

Abstract

BACKGROUND

Leptospirosis is the most widespread zoonosis in the world. Cardiac involvement is a frequent complication of leptospirosis although significant left ventricular dysfunction is rare. We report a case of fatal leptospira myocarditis leading to cardiogenic shock on the second day of illness. This early occurrence of myocarditis is not previously reported.

CASE PRESENTATION

A 36-yr-old previously healthy Sri Lankan male who takes care of a horse presented to the medical casualty ward with a one day history of fever, arthralgia and severe myalgia. He developed hypotension on the second day of illness. Electrocardiogram showed sinus tachycardia with ST segment depression in lateral leads which evolved in to rapid atrial fibrillation in the subsequent days. 2D echocardiogram showed dilated cardiac chambers with severe global hypokinesia and an ejection fraction of 20%. His renal and liver functions were within normal limits. He developed multi organ dysfunction syndrome and refractory shock, later in the course of illness. Leptospirosis was confirmed by positive leptospira IgM and negative IgG. Patient died on the fifth day of illness despite optimal medical treatment with intravenous penicillin, meropenem, levofloxacin, inotropes and supportive care in the intensive care unit.

CONCLUSIONS

We describe a rare and unusual early complication of leptospirosis which has not been reported before. It is important to bear in mind that leptospirosis could present as myocarditis during the early phase of illness.

Authors+Show Affiliations

Ward 01, Colombo South Teaching Hospital, Kalubowila, Sri Lanka. jagathsltt@yahoo.com. University Medical Unit, CSTH, Kalubowila, Sri Lanka. jagathsltt@yahoo.com. Department of Medicine, Faculty of Medical Sciences, USJP, Nugegoda, Sri Lanka. jagathsltt@yahoo.com.Ward 01, Colombo South Teaching Hospital, Kalubowila, Sri Lanka. thushanthy.prasath@gmail.com. University Medical Unit, CSTH, Kalubowila, Sri Lanka. thushanthy.prasath@gmail.com.Ward 01, Colombo South Teaching Hospital, Kalubowila, Sri Lanka. ganaja007@yahoo.co.uk. University Medical Unit, CSTH, Kalubowila, Sri Lanka. ganaja007@yahoo.co.uk.Ward 01, Colombo South Teaching Hospital, Kalubowila, Sri Lanka. sugandika23@gmail.com. University Medical Unit, CSTH, Kalubowila, Sri Lanka. sugandika23@gmail.com.Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Kalubowila, Sri Lanka. nilanka.dushani@gmail.com. University Medical Unit, CSTH, Kalubowila, Sri Lanka. nilanka.dushani@gmail.com. Department of Medicine, Faculty of Medical Sciences, USJP, Nugegoda, Sri Lanka. nilanka.dushani@gmail.com.Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Kalubowila, Sri Lanka. indrak2004@gmail.com. University Medical Unit, CSTH, Kalubowila, Sri Lanka. indrak2004@gmail.com. Department of Medicine, Faculty of Medical Sciences, USJP, Nugegoda, Sri Lanka. indrak2004@gmail.com.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25884600

Citation

Pushpakumara, Jagath, et al. "Myocarditis Causing Severe Heart Failure--an Unusual Early Manifestation of Leptospirosis: a Case Report." BMC Research Notes, vol. 8, 2015, p. 80.
Pushpakumara J, Prasath T, Samarajiwa G, et al. Myocarditis causing severe heart failure--an unusual early manifestation of leptospirosis: a case report. BMC Res Notes. 2015;8:80.
Pushpakumara, J., Prasath, T., Samarajiwa, G., Priyadarshani, S., Perera, N., & Indrakumar, J. (2015). Myocarditis causing severe heart failure--an unusual early manifestation of leptospirosis: a case report. BMC Research Notes, 8, 80. https://doi.org/10.1186/s13104-015-1031-1
Pushpakumara J, et al. Myocarditis Causing Severe Heart Failure--an Unusual Early Manifestation of Leptospirosis: a Case Report. BMC Res Notes. 2015 Mar 13;8:80. PubMed PMID: 25884600.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Myocarditis causing severe heart failure--an unusual early manifestation of leptospirosis: a case report. AU - Pushpakumara,Jagath, AU - Prasath,Thushanthy, AU - Samarajiwa,Ganaja, AU - Priyadarshani,Sugandika, AU - Perera,Nilanka, AU - Indrakumar,Jegarajah, Y1 - 2015/03/13/ PY - 2014/10/08/received PY - 2015/02/23/accepted PY - 2015/4/18/entrez PY - 2015/4/18/pubmed PY - 2015/12/15/medline SP - 80 EP - 80 JF - BMC research notes JO - BMC Res Notes VL - 8 N2 - BACKGROUND: Leptospirosis is the most widespread zoonosis in the world. Cardiac involvement is a frequent complication of leptospirosis although significant left ventricular dysfunction is rare. We report a case of fatal leptospira myocarditis leading to cardiogenic shock on the second day of illness. This early occurrence of myocarditis is not previously reported. CASE PRESENTATION: A 36-yr-old previously healthy Sri Lankan male who takes care of a horse presented to the medical casualty ward with a one day history of fever, arthralgia and severe myalgia. He developed hypotension on the second day of illness. Electrocardiogram showed sinus tachycardia with ST segment depression in lateral leads which evolved in to rapid atrial fibrillation in the subsequent days. 2D echocardiogram showed dilated cardiac chambers with severe global hypokinesia and an ejection fraction of 20%. His renal and liver functions were within normal limits. He developed multi organ dysfunction syndrome and refractory shock, later in the course of illness. Leptospirosis was confirmed by positive leptospira IgM and negative IgG. Patient died on the fifth day of illness despite optimal medical treatment with intravenous penicillin, meropenem, levofloxacin, inotropes and supportive care in the intensive care unit. CONCLUSIONS: We describe a rare and unusual early complication of leptospirosis which has not been reported before. It is important to bear in mind that leptospirosis could present as myocarditis during the early phase of illness. SN - 1756-0500 UR - https://www.unboundmedicine.com/medline/citation/25884600/Myocarditis_causing_severe_heart_failure__an_unusual_early_manifestation_of_leptospirosis:_a_case_report_ L2 - https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-015-1031-1 DB - PRIME DP - Unbound Medicine ER -