Iunia – Elena Ciuchi – Nicolau 1
1 5th year resident physician – Internal Medicine. Clinic of Internal Medicine II, University Emergency Hospital PhD student in Infectious Diseases at the Institute for Infectious Diseases „Prof. Dr. Matei Balş” Bucharest
Abstract
We report the case of a 29-year-old man who, after having been exposed to non-potable water, had developed an acute myocarditis due to a Leptospira icterohaemorrhagiae leptospirosis, a severe form with renal, hepatic and hematologic involvement (Weil’s disease). The clinical signs at hospital admission were: fever, jaundice, hemorrhagic syndrome and oligoanuria. The etiological diagnosis was confirmed by the serological microagglutination test, which was positive for Leptospira icterohaemorrhagiae. An electrocardiography revealed an atrial flutter with variable block and an echocardiography identified a medium hypertrophy of the left ventricle and a medium systolic dysfunction, these findings leading to the diagnosis of acute myocarditis. The clinical status of the patient was not suitable for electroconversion of the atrial flutter, and thus the cardiologist prescribed diltiazem. The evolution was slowly favorable under treatment with ceftriaxone, dexamethasone and diltiazem, with full recovery of the patient, including that of the cardiologic parameters. The early diagnosis of leptospiral myocarditis is important because of its potential severity and its reversibility under appropriate antibiotic therapy and also because of the necessity of its initial management in a specific infrastructure.