Acute coronary syndrome or cardiac involvement due to leptospirosis: A case report

Abstract

Leptospirosis is a globally prevalent zoonotic infection. Cardiac involvement in leptospirosis, including myocarditis, can be easily missed due to non-specific symptoms and concurrent multiorgan dysfunction. A 46-year-old male presented to the emergency department with weakness, fever, palpitations, and widespread joint and muscle pain. His temperature was 40°C, and his blood pressure dropped to 50/30 mm Hg. The patient, with elevated high-sensitivity troponin levels in laboratory findings, was referred to the cardiology department. Anti-ischemic treatment was started for a preliminary diagnosis of acute coronary syndrome. The leptospirosis polymerase chain reaction (PCR) test in serum was positive, whereas the urine Leptospira PCR test was negative. The patient presented with septic shock and elevated cardiac biomarkers and was re-evaluated based on electrocardiogram and echocardiogram findings. Considering these clinical and laboratory results, acute coronary syndrome was ruled out, and myocardial involvement due to leptospirosis was considered. This case highlights the importance of recognizing cardiac involvement in leptospirosis.