Dewi Ivana P, Damayanti Kadex Rs, Anggitama Andreas M, Bagaskara Arya T, Dewi Kristin P, Yusrizal Teuku
Faculty of Medicine, Universitas Kristen Duta Wacana, Yogyakarta, Indonesia.
Department of Cardiology and Vascular Medicine, Bethesda Hospital, Yogyakarta, Indonesia.
Narra J. 2025 Aug;5(2):e1978. doi: 10.52225/narra.v5i2.1978. Epub 2025 Apr 21.
Although leptospirosis is a well-recognized zoonotic disease, the occurrence of ST-segment-elevation myocardial infarction (STEMI)-mimicking leptospiral myocarditis, accompanied by subsequent bleeding and thrombocytopenia is an exceptionally rare finding. The dual risks of bleeding and thrombosis further complicate the management of anticoagulation and thrombolytic therapy amidst competing risks. The aim of this study was to present leptospirosis complicated by myocarditis, which mimicked STEMI, followed by bleeding and thrombocytopenia. A 61-year-old male patient was referred from a community health center to the hospital with primary complaints of chest discomfort and diaphoresis, which had started 11 hours prior to admission. These symptoms were associated with a 12-day history of intermittent fever, nausea, and vomiting. Upon physical examination, the patient appeared lethargic, with a blood pressure of 86/63 mmHg, heart rate of 107 bpm, respiratory rate of 22 breaths per minute, and temperature of 39.8°C. Electrocardiography revealed widespread ST-segment elevation. Echocardiography showed global hypokinesia with a reduced ejection fraction of 48%. Laboratory tests confirmed the presence of IgM and IgG anti- antibodies, along with elevated high-sensitivity cardiac troponin levels. The patient was diagnosed with Weil's disease (Faine's score 32), with leptospiral myocarditis and STEMI considered as differential diagnoses. Initial management involved a loading dose of dual antiplatelet therapy (aspirin 320 mg and clopidogrel 300 mg) due to the suspected diagnosis of STEMI. However, it was later discontinued on the second day of admission due to the development of severe thrombocytopenia and minor bleeding manifestations. Following the administration of ceftriaxone 2 g every 12 hours and doxycycline 100 mg every 12 hours, the patient's condition improved. This case highlights the importance of recognizing leptospirosis as a potential cause of myocarditis and thrombocytopenia, especially when clinical signs resemble those of STEMI. Early diagnosis and careful management, including the suspension of dual antiplatelet therapy and initiation of targeted antibiotic therapy, were pivotal in preventing further complications and improving the patient's outcomes.
尽管钩端螺旋体病是一种广为人知的人畜共患病，但出现类似ST段抬高型心肌梗死（STEMI）的钩端螺旋体性心肌炎，并伴有随后的出血和血小板减少的情况极为罕见。出血和血栓形成的双重风险在存在多种相互竞争风险的情况下，使抗凝和溶栓治疗的管理更加复杂。本研究的目的是介绍并发心肌炎的钩端螺旋体病，该病类似STEMI，随后出现出血和血小板减少。一名61岁男性患者从社区卫生中心转诊至医院，主要主诉为胸部不适和出汗，这些症状在入院前11小时开始出现。这些症状伴有12天的间歇性发热、恶心和呕吐病史。体格检查时，患者显得嗜睡，血压为86/63 mmHg，心率为107次/分钟，呼吸频率为22次/分钟，体温为39.8°C。心电图显示广泛的ST段抬高。超声心动图显示整体运动减弱，射血分数降低至48%。实验室检查证实存在IgM和IgG抗体，同时高敏心肌肌钙蛋白水平升高。患者被诊断为韦尔病（费恩评分32），钩端螺旋体性心肌炎和STEMI被视为鉴别诊断。由于疑似STEMI诊断，初始治疗包括负荷剂量的双联抗血小板治疗（阿司匹林320 mg和氯吡格雷300 mg）。然而，由于出现严重血小板减少和轻微出血表现，在入院第二天停用。在每12小时给予2 g头孢曲松和每12小时给予100 mg强力霉素后，患者病情好转。该病例强调了认识到钩端螺旋体病是心肌炎和血小板减少的潜在原因的重要性，特别是当临床体征类似于STEMI时。早期诊断和仔细管理，包括停用双联抗血小板治疗和开始针对性抗生素治疗，对于预防进一步并发症和改善患者预后至关重要。
