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BMC Research Notes

, 8:80

First Online: 13 March 2015Received: 08 October 2014Accepted: 23 February 2015DOI: 10.1186-s13104-015-1031-1

Cite this article as: Pushpakumara, J., Prasath, T., Samarajiwa, G. et al. BMC Res Notes 2015 8: 80. doi:10.1186-s13104-015-1031-1


BackgroundLeptospirosis 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 presentationA 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.

ConclusionsWe 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.

KeywordsLeptospirosis Myocarditis Left ventricular dysfunction AbbreviationsLVLeft Ventricle


CXRChest X ray

CRPC reactive protein

CVPCentral Venous Pressure

ICUIntensive Care Unit

TLRToll like Receptors

ALTAlanine Transaminase

ASTAspartate Transaminase

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Autor: Jagath Pushpakumara - Thushanthy Prasath - Ganaja Samarajiwa - Sugandika Priyadarshani - Nilanka Perera - Jegarajah Indrakum


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