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- Title
Myocarditis, pancreatitis, polyarthritis, mononeuritis multiplex and vasculitis with symmetrical peripheral gangrene of the lower extremities as a rare presentation of leptospirosis: a case report and review of the literature.
- Authors
Panagopoulos, Periklis; Terzi, Irene; Karanikas, Michail; Galanopoulos, Nikolaos; Maltezos, Efstratios
- Abstract
Introduction Leptospirosis is a zoonosis caused by the spirochete, Leptospira interrogans. While most cases of leptospirosis are mild to moderate, the course may be complicated by multiorgan dysfunction. We present a rare case of leptospirosis with acute myocarditis, pancreatitis, polyarthritis, mononeuritis multiplex and severe vasculitis with necrosis of the extremities. Case presentation A 32-year-old man from Congo presented with high-grade fever, confusion and headache. He developed tachycardia and hypotension followed by electrocardiogram changes and elevation of troponin I levels suggesting myocarditis. A physical examination revealed conjunctival suffusion, polyarthritis of his lower extremities and cutaneous necrosis of his feet due to vasculitis. Laboratory findings included amylase levels 10-fold the upper normal serum levels and thrombocytopenia. The diagnosis was confirmed by a positive leptospira immunoglobulin M, negative immunoglobulin G and a positive rapid agglutination test. Our patient recovered progressively with antimicrobials and supportive care. Conclusions Because the clinical features and diagnostic findings of leptospirosis are not specific, a high index of suspicion must be maintained for the diagnosis. Serology is the most important tool for accurate and quick diagnosis in order to administer the appropriate therapy.
- Subjects
SPIROCHAETOSIS; MYOSITIS; LEPTOSPIROSIS; PANCREATITIS; GANGRENE; ANTIGEN-antibody reactions; BLOOD plasma
- Publication
Journal of Medical Case Reports, 2014, Vol 8, Issue 1, p1
- ISSN
1752-1947
- Publication type
Case Study
- DOI
10.1186/1752-1947-8-150