Severe Leptospirosis with Myocarditis and Pneumonia Presenting as Nodal Bradycardia: A Brief Case Report

Leptospirosis is a zoonotic infection that can lead to severe multi-organ dysfunction, including cardiac and pulmonary complications.We present the case of a 25-year-old farmer who presented with high-grade fever, arthralgia, pleuritic chest pain, and presyncopal episodes.Initial investigations showed nodal bradycardia, thrombocytopenia and Dengue NS1 Ag negativity.Upon transfer to our unit, he exhibited tachypnea, persistent bradycardia, hypotension, and bibasal lung crepitations.Differential diagnoses included atypical pneumonia or leptospirosis with myocarditis.Further investigation revealed global hypokinesia with an ejection fraction of 25%, a thin rim of pericardial effusion, and elevated troponin I levels, indicating myopericarditis.High-resolution computed tomography chest excluded pulmonary hemorrhage but showed bilateral basal patchy consolidations.The patient improved with supportive care, including IV methylprednisolone, IV ceftriaxone, vasopressors, temporary pacemaker followed by IV atropine and isoprenaline and antibiotics.He was discharged on day 5 with oral doxycycline.The serology confirmed leptospirosis leading to a final diagnosis of leptopneumonia with leptomyopericarditis.This case highlights the challenges in diagnosing and managing leptospirosis with cardiac and pulmonary involvement.