Acute Myopericarditis An Uncommon Presentation of Severe Leptospirosis

Jayakanthan S, Manimaran R, Sathyanarayanan M, Bharathi Raja K

Several case reports show asymptomatic cardiovascular involvement in severe leptospirosis. follow up needed in all patients with uncomplicated leptospirosis and cardiac vascular involvement evaluation with an ECG and cardiac enzymes to avoid complications to the patient.

Abstract

Leptospira infrequently involves the Cardiovascular system due to underestimated statistics. This case is a 45 years old male, a daily laborer residing in the chengalpattu district of Tamilnadu, a tropical endemic area for Leptospira. The patient initially came to OPD with fever, headache and myalgias. All investigations were done, and was diagnosed Leptospirosis (Ig M positive and MAT positive), and specific treatment was given. Patient had mild chest pain and got admitted in hospital after a week. Echocardiography showed pericardial fluid (approximately 200 cc) with no cardiac tamponade and pericardial thickening. ECG showed supraventricular arrhythmia (with normal previous ECG) and elevated cardiac biomarkers. Many case reports show asymptomatic cardiovascular involvement in severe leptospirosis. follow up needed in all patients with uncomplicated leptospirosis and cardiac vascular involvement evaluation with an ECG and cardiac enzymes to avoid complications to the patient.

Keywords: Leptospira, Echocardiography, pericardial fluid, ECG.

References

Abdulkader RC, Daher EF, Camargo ED, Spinosa C, da Silva MV (2002) Leptospirosis severity may be associated with the intensity of humoral immune response. Rev Inst Med Trop Sao Paulo 44: 79-83.

https://doi.org/10.1590/S0036-46652002000200005

Adelina Braselli. Leptospirosis.

Andre V Lomar, Decio Diament, Jaime R Torres (2000) Leptospirosis in Latin America. Emerging and re-emerging Diseases in Latin America. Infect Dis Clin 14: 23-39.

https://doi.org/10.1016/S0891-5520(05)70216-6

Constans J, Gosse P, Cottarre M, Ansoborlo P, Mercie P, et al. (1996) Myopericarditis and atrial fibrillation disclosing leptospirosis septicemia. Presse Med 25: 555.

Galluzzo A, Imazio M (2018) Advances in medical therapy for pericardial diseases. Expert Rev Cardiovasc Ther 16: 635-643.

https://doi.org/10.1080/14779072.2018.1510315

Jorge O Alarcón-Villaverde, Franco Romani-Romani, Romina A Tejada, Paolo Wong-Chero, Manuel Céspedes-Zambrano (2014) Seroprevalencia de leptospirosis y características asociadas en agricultores de arroz de una región tropical del Peru. Rev Med Exp Saludpublica 31: 195-203.

https://doi.org/10.17843/rpmesp.2014.312.35

Lucht F, Lafond P, Bertrand JC (1996) Myopericarditis and auricular fibrillation disclosing septicemic leptospirosis. Presse Med 25: 1805.

Shah K, Amonkar GP, Kamat RN, Deshpande JR (2010) Cardiac findings in leptospirosis. J ClinPathol 63: 119-123.

https://doi.org/10.1136/jcp.2009.069575

Škerk V, Markotic A, Puljiz I, Kuzman I, Celjuska ToŠev E, et al. (2011) Electrocardiographic changes in hospitalized patients with leptospirosis over a 10-year period. Med Sci Monit 17: 369-375.

https://doi.org/10.12659/MSM.881847