Suspected myocarditis resulting from leptospirosis: A case report from Iran

Leptospirosis is a potentially fatal disease that can lead to dysfunction across multiple organ systems. Although cardiovascular complications are relatively rare, they are frequently underestimated and may result in severe outcomes if not addressed promptly. A 46-year-old farmer presented with complaints of palpitations and chest pain. He reported a history of fever, chills, rigors, diaphoresis, myalgia, nausea, low back pain, and headaches that began 7 days prior. An electrocardiogram showed diffuse T-wave inversions and sinus tachycardia; a troponin test was positive, indicating myocardial injury. Echocardiography revealed generalized wall motion abnormalities and left ventricular systolic dysfunction. After 5 days of antibiotic treatment and a 3-day course of corticosteroids, the patient fully recovered and was discharged without any complications. His angiography was normal, and leptospiral IgM was highly positive. Severe leptospirosis should be considered a potential cause of myocarditis, especially in patients with occupational risk factors and those living in endemic regions. Given the non-specific clinical features and diagnostic findings of leptospirosis, it is essential to maintain a high level of suspicion. Timely clinical recognition and laboratory confirmation are crucial, as delays can lead to higher mortality.