383: MYOCARDITIS DUE TO LEGIONELLA: A CASE REPORT

Abstract

Introduction: Legionnaires’ disease is pneumonia caused due to Legionella species. Among the rare extrapulmonary manifestations, cardiac involvement is most prevalent in myocarditis, pericarditis, post-cardiotomy syndrome, and prosthetic valve endocarditis. The morbidity and mortality associated with such an uncommon presentation of legionella myocarditis are quite high. We describe a rare case of Legionella myocarditis in a 35-year-old female associated with acute left ventricular dysfunction with sepsis and pneumonitis. Description: The patient presented with fever, headache, giddiness, chills, myalgias, generalized body aches, altered mental sensorium, acute onset dyspnea, hypoxemia (83%), low blood pressure (86/56 mm Hg), respiratory failure, renal failure, and ischemic hepatic injury. She was intubated and stabilized with multiple inotropes. Echocardiography (Echo) showed borderline increase in cardiac chambers with severe, and mild mitral regurgitation (MR), mild tricuspid regurgitation (TR). The estimated LV ejection fraction (LVEF) was 10-15% with grade III LV diastolic dysfunction. X-ray showed haziness in the right lower zone with blunting of the right CP angle. She was admitted in the intensive care unit for 8 days. Due to significantly raised cardiac biomarkers (Troponin), borderline dilated chambers, and severe LV dysfunction on echocardiogram, a provisional diagnosis of fulminant myocarditis was made. Legionella infection was diagnosed on the basis of a serum pneumoslide IgM test. Although the result from the biopsy would have strengthened the diagnosis, but it was too risky. After appropriate medication, the patient improved significantly and transferred to the floor. After 10 days of monitoring, the patient was discharged and was advised follow-up after 1 week. She recovered fully and follow-up echocardiography showed marked improvement in the cardiac function. Echo Images will be presented during poster presentation. Discussion: A high degree of clinical suspicion and a thorough history is needed to suspect legionella infection. The prognosis of Legionella myocarditis depends on systemic involvement, comorbidities, and the delay before beginning directed therapy.