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.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors.affiliation: 2nd University Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece. ppanago@med.duth.gr.
authors.forename: Periklis
authors.initials: P
authors.lastname: Panagopoulos
authors.forename: Irene
authors.initials: I
authors.lastname: Terzi
authors.forename: Michail
authors.initials: M
authors.lastname: Karanikas
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Galanopoulos
authors.forename: Efstratios
authors.initials: E
authors.lastname: Maltezos
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001168:Arthritis / Q000175:diagnosis* / Q000209:etiology; D005734:Gangrene / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007922:Leptospirosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D035002:Lower Extremity / Q000473:pathology*; D008297:Male; D020422:Mononeuropathies / Q000175:diagnosis* / Q000209:etiology; D009205:Myocarditis / Q000175:diagnosis* / Q000209:etiology; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology; D010406:Penicillins / Q000627:therapeutic use; D014657:Vasculitis / Q000175:diagnosis* / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins