Cardiovascular Manifestations of Leptospirosis: A Case of Myopericarditis in an Endemic Region

Jayakanthan S ¹, Manimaran R ¹, Sathyanarayanan M ^1*, Bharathi Raja K ¹

This study showed the need for cardiovascular evaluation in leptospirosis patients, especially in endemic areas, to prevent severe cardiac complications.

Abstract

Background: Leptospirosis, caused by the spirochete bacterium Leptospira, is predominantly recognized for its systemic manifestations involving the liver, kidneys, and central nervous system. Cardiovascular involvement, though less common, is frequently underestimated and may lead to severe complications if not addressed promptly. Methods: This case study reports on a 45-year-old male laborer from Chengalpattu, Tamil Nadu, an endemic area for leptospirosis. The patient initially presented with fever, headache, and myalgias. Diagnosis was confirmed through positive IgM antibodies and Microscopic Agglutination Test (MAT). Following initial treatment with doxycycline, the patient experienced mild chest pain and was admitted a week later. Diagnostic procedures included echocardiography and electrocardiography (ECG), which identified pericardial fluid, pericardial thickening, supraventricular arrhythmias, and elevated cardiac biomarkers. Results: Echocardiography revealed approximately 200 cc of pericardial fluid without cardiac tamponade and pericardial thickening. The ECG showed supraventricular arrhythmias and elevated cardiac biomarkers, including Creatine Phosphokinase (CPK) and Troponin I. These findings suggested acute myopericarditis secondary to leptospirosis. The patient was treated with anti-inflammatory medications, including NSAIDs, colchicine, and low-dose corticosteroids. Conclusion: This case underscores the importance of considering cardiovascular involvement in leptospirosis, particularly in endemic areas. Although rare, leptospirosis can present with severe cardiac complications such as myopericarditis. Comprehensive follow-up, including ECG and cardiac enzyme monitoring, is essential for managing potential complications and ensuring favorable patient outcomes. Early recognition and appropriate treatment are crucial to addressing these rare but serious manifestations of leptospirosis.

Keywords: Leptospirosis, Myopericarditis, Cardiovascular involvement, Endemic regions, Cardiac biomarkers

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