title: Myocarditis causing severe heart failure--an unusual early manifestation of leptospirosis: a case report.
abstract: BACKGROUND
  Leptospirosis 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.
  
  
  METHODS
  A 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.
  
  
  CONCLUSIONS
  We 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.
authors.affiliation: Ward 01, Colombo South Teaching Hospital, Kalubowila, Sri Lanka. jagathsltt@yahoo.com.|University Medical Unit, CSTH, Kalubowila, Sri Lanka. jagathsltt@yahoo.com.|Department of Medicine, Faculty of Medical Sciences, USJP, Nugegoda, Sri Lanka. jagathsltt@yahoo.com.
authors.forename: Jagath
authors.initials: J
authors.lastname: Pushpakumara
authors.affiliation: Ward 01, Colombo South Teaching Hospital, Kalubowila, Sri Lanka. thushanthy.prasath@gmail.com.|University Medical Unit, CSTH, Kalubowila, Sri Lanka. thushanthy.prasath@gmail.com.
authors.forename: Thushanthy
authors.initials: T
authors.lastname: Prasath
authors.affiliation: Ward 01, Colombo South Teaching Hospital, Kalubowila, Sri Lanka. ganaja007@yahoo.co.uk.|University Medical Unit, CSTH, Kalubowila, Sri Lanka. ganaja007@yahoo.co.uk.
authors.forename: Ganaja
authors.initials: G
authors.lastname: Samarajiwa
authors.affiliation: Ward 01, Colombo South Teaching Hospital, Kalubowila, Sri Lanka. sugandika23@gmail.com.|University Medical Unit, CSTH, Kalubowila, Sri Lanka. sugandika23@gmail.com.
authors.forename: Sugandika
authors.initials: S
authors.lastname: Priyadarshani
authors.affiliation: Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Kalubowila, Sri Lanka. nilanka.dushani@gmail.com.|University Medical Unit, CSTH, Kalubowila, Sri Lanka. nilanka.dushani@gmail.com.|Department of Medicine, Faculty of Medical Sciences, USJP, Nugegoda, Sri Lanka. nilanka.dushani@gmail.com.
authors.forename: Nilanka
authors.initials: N
authors.lastname: Perera
authors.affiliation: Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Kalubowila, Sri Lanka. indrak2004@gmail.com.|University Medical Unit, CSTH, Kalubowila, Sri Lanka. indrak2004@gmail.com.|Department of Medicine, Faculty of Medical Sciences, USJP, Nugegoda, Sri Lanka. indrak2004@gmail.com.
authors.forename: Jegarajah
authors.initials: J
authors.lastname: Indrakumar
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D004452:Echocardiography; D017809:Fatal Outcome; D005334:Fever / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units; D007922:Leptospirosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D008297:Male; D009205:Myocarditis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D012770:Shock, Cardiogenic / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents