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Open Access Highly Accessed Case report

Pancreatitis and myocarditis followed by pulmonary hemorrhage, a rare presentation of leptospirosis- A case report and literature survey

Nuwan Ranawaka1*, Vijayabala Jeevagan1, Panduka Karunanayake2 and Saroj Jayasinghe2

Author Affiliations

1 University Medical Unit, National Hospital of Sri Lanka, Colombo, 10, 01000, Sri Lanka

2 Department of Medicine, Faculty of Medicine, University of Colombo, Colombo, 08, 00800, Sri Lanka

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BMC Infectious Diseases 2013, 13:38  doi:10.1186/1471-2334-13-38

Published: 24 January 2013

Abstract

Background

Leptospirosis is a potentially fatal disease which can cause multi-organ dysfunction. It can rarely present as acute pancreatitis. This is the first ever report of leptospirosis presenting with acute pancreatitis and myocarditis followed by diffuse pulmonary hemorrhages to the best of our knowledge.

Case presentation

A 15-year-old South Asian boy presented with high grade fever, epigastric discomfort and was anicteric on admission. He developed tachycardia, transient hypotension, changes of electro-cardiogram and positive troponin I suggestive of myocarditis. Acute pancreatitis was diagnosed with 12 fold high serum amylase and with the evidence of computerized tomography. Then he developed diffuse pulmonary hemorrhages and later acute renal failure. Leptospirosis was confirmed by positive leptospira IgM, negative IgG and strongly positive Microscopic Agglutination Test. Other possible infective and autoimmune causes were excluded. Patient recovered completely with antibiotics and the supportive care.

Conclusion

This case illustrates diagnostic difficulties especially in resource poor settings where leptospirosis is common. Additionally it highlights the fact that leptospirosis should be considered in patients presenting with pancreatitis which can be complicated with myocarditis and diffuse pulmonary hemorrhages. We hypothesize that Toll like receptors may play a role in such systemic involvement.

Keywords:
Leptospirosis; Pancreatitis; Myocarditis; Pulmonary hemorrhage; Toll like receptors