Cardiac Haemorrhage: An Extreme Presentation of Leptospirosis
Keywords:Leptospirosis; Myocarditis; Pulmonary haemorrhage; Autopsy; Cardiac haemorrhage
Introduction: Leptospirosis is a worldwide disease with significant morbidity and mortality. The severe
form of the disease may present with cardiac and pulmonary involvements resulting in multi-organ
failure. Cardiac manifestations of leptospirosis include arrhythmia, cardiomegaly, petechial haemorrhages,
pericarditis and myocarditis. Case report: We report a case of a 10-year-old boy who was having shortness
of breath and collapsed at home. At the emergency department, he was having refractory hypotension
with electrocardiogram (ECG) showing sinus tachycardia. The liver and cardiac enzymes were markedly
raised. The full blood count showed leukocytosis. It was concluded that he was in septicaemic state with
acute multi-organ failure of unknown cause. He succumbed to the illness approximately 8 hours after the
hospital admission. At autopsy, the lungs, liver and spleen were markedly congested. Pericardial effusion
was noted. The heart showed extensive areas of petechial and confluent haemorrhages involving almost
the entire epicardial surface of the right and left ventricles. Massive subendocardial haemorrhage was also
observed upon sectioning of the left ventricular chamber. Histopathology examination corroborated that
haemorrhages were present in the heart, lungs and the liver. Laboratory investigations revealed positive
Leptospira IgM antibody, confirmed by positive Leptospira PCR. The cause of death was concluded as
cardiac and pulmonary haemorrhages secondary to leptospirosis. Conclusion: Cardiovascular involvement
in leptospirosis may manifest as rapidly deteriorating illness with clinical evidence demonstrable from the
ECG changes and raised cardiac enzymes. Recognizing these signs early may help to improve outcomes.
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