--- a +++ b/processing/MACCROBAT/25884600.txt @@ -0,0 +1,29 @@ +A 36-yr-old previously healthy Sri Lankan male who takes care of a horse presented to the medical casualty ward with fever, arthralgia and myalgia for one day. +He complained of mild dysuria but had normal urine output. +He did not have chest pain or shortness of breath. +Further inquiry revealed that he was treated for leptospirosis during a febrile illness in the past. +On examination, patient was afebrile, anicteric. +His blood pressure was 90/60 mmHg and pulse rate 76 bpm. +Rest of the examination was unremarkable. +Initial investigations performed on the day of admission revealed neutrophil leukocytosis, mild thrombocytopaenia and microscopic haematuria (Table 1). +Renal function and liver enzymes were within normal limits. +Urine analysis revealed pus cells 05 – 06 /hpf, red cells 30 – 35 /hpf. +CRP (C-reactive protein) was 75 mg/dl. +A clinical diagnosis of leptospirosis was made and he was started on intravenous penicillin in addition to adequate hydration. +On the second day of illness, he developed hypotension with tachycardia and dyspnoea. +ECG revealed sinus tachycardia with ST depression in leads V4 – V6 [Figure 1]. +His CXR (chest x ray) showed gross cardiomegaly and bilateral pulmonary shadows [Figure 2]. +CVP (central venous pressure) was 16 cmH2O and 2D echocardiogram revealed dilatation of all four chambers, severe global hypokinesia and ejection fraction of 20%. +Troponin I was 12.77 ng/ml (normal range < 0.40). +He was diagnosed to have early and severe myocarditis. +Patient was transferred to ICU (intensive care unit) as he needed inotropic support. +Intravenous antibiotics including penicillin, meropenem and levofloxacin were continued. +Patient was electively ventilated on the 3rd day of illness due to severe respiratory distress. +On the same day, he developed rapid atrial fibrillation [Figure 3] unresponsive to digoxin and intravenous amiodarone. +Platelet count dropped to 10 × 103 μ/L and he was given platelet transfusions to prevent bleeding [Table 1]. +We started intravenous methylprednisolone based on previous studies showing a mortality benefit in severe leptospirosis complicated with myocarditis [11]. +His serum creatinine increased to 362 μ mol/L by the 5th day of illness and ALT (alanine transaminase) and AST (aspartate transaminase) were markedly elevated up to 2726 U/l and 7438 U/l respectively. +Dengue and Mycoplasma infections were excluded. +Blood cultures were negative. +Leptospira IgM antibody performed on the 5th day of illness was positive (IgG negative). +Patient developed refractory shock and died of persistent ventricular tachycardia despite optimal treatment in the ICU.