Introduction
A 45-year-old Alexander, who came from Chengalpattu endemic area for leptospirosis and Malaria. Initially he presented to the Hospital with high-grade fever, headache, and myalgias, and he was tested for Leptospirosis, confirmed by positive Leptospira IgM, negative IgG, and highly positive Microscopic Agglutination Test, and indicated doxycycline (for 6 days course). He was admitted with mild chest pain, severe lower limb edema, acute headache, polymyalgia, and foamy urine. Although, on admission we ruled out any hepatic, kidney, pulmonary, and cardiac complications, at that point, he was presenting a leptospirosis infection.
On examination
Patient in poor general condition, b/l lower limb edema, eyes look red.
Cardiovascular: Rhythm, tachycardia, no murmurs; All other system examination is unremarkable.
Laboratory
Elisa for leptospirosis: Microagglutination reagent in tube (MAT); Leptospirosis: Autummalis 1/400/Canicola 1/200; Chest X-ray: Increased cardiac silhouette with atrial effacement and right ventricle edges. He presented with chest pain and echocardiography: pericardial fluid (approximately 200 cc) with no cardiac tamponade, thickening of visceral and parietal (+/- 5mm) pericardium and electrocardiogram shows simple and aberrant supraventricular arrhythmia with isolated extrasystoles and raised cardiac enzymes (Creatine phosphokinase: 800 U/L, Creatine phosphokinase-M: 5 ng/ml, Myoglobin: 143 ng/ml and Troponin I: 0.9 ng/ml) Proteinuria: 0.86g/24h.
Leptospirosis with chest pain associated with the laboratory and imaging and the Reactive MAT, gives a differential diagnosis of rare manifestation of Myopericarditis due to Severe Leptospira. In addition, other infective and autoimmune aetiologies were excluded, such as dengue haemorrhagic fever or other arboviruses, autoimmune multi-system disorders such as systemic lupus erythematosus, and vasculitis were also differentiated. The patient recovered with antibiotics and anti-inflammatory medication to ensure the pericardial complication.