Cardiac Involvement in Leptospirosis – An Unusual Manifestation

Authors

• Vanessa Barcelos Internal Medicine Department, Hospital Do Divino Espírito Santo, Ponte Delgada, Portugal
• Ana Carolina Ferreira Internal Medicine Department, Hospital Do Divino Espírito Santo, Ponte Delgada, Portugal
• António Xavier Fontes Cardiology Department, Hospital Do Divino Espírito Santo, Ponte Delgada, Portugal
• Luís Dias Internal Medicine Department, Hospital Do Divino Espírito Santo, Ponte Delgada, Portugal
• Humberto Costa Intensive care Department, Hospital Do Divino Espírito Santo, Ponte Delgada, Portugal
• Dinis Martins Cardiology Department, Hospital Do Divino Espírito Santo, Ponte Delgada, Portugal

vanessavieirabarcelos@gmail.com

Keywords

Abstract

Cardiovascular involvement by Leptospira is unusual. We report a case of a 29-year-old male sanitation worker who was diagnosed with leptospirosis (PCR testing for Leptospira spp. was positive in blood and urine). He had no classical clinical findings, and the presence of shock was the main worrisome finding. Within 24 hours of admission, the emergence of chest pain led us to consider cardiac involvement, which was demonstrated by diffuse supra-ST segment elevation, elevated troponin and NT-proBNP and an echocardiogram showing mildly left ventricular ejection fraction (LVEF 48–50%). There are several reports of cardiovascular involvement in severe leptospirosis but most patients are asymptomatic. In this case, the main key to diagnosis of perimyocarditis was the new onset of chest pain.