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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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MYOSITIS, AN ATYPICAL PRESENTATION OF LEPTOSPIROSIS

Mariana Duarte1; Catarina Gouveia1; Jose Pedro Vieira2; Maria João Brito1

1. Infectious Disease Unit, Hospital de Dona Estefânia Centro Hospitalar Lisboa Central, Lisbon. Portugal
2. Neurologic Unit, Hospital de Dona Estefânia Centro Hospitalar Lisboa Central, Lisbon. Portugal

- 10th World Congress of the World Society for Pediatric Infectious Diseases (Poster)

Introduction: Leptospirosis is associated with a broad spectrum of severity ranging from subclinical illness following a biphasic course (septicemic and immunologic). Infectious myositis is uncommon but leptospira can act as a trigger for inflammatory muscular disease.
Case Report: A 17-year-old male presented with left hip pain and intermittent limp for 2 weeks that became bilateral and showed no improvement with anti-inflammatory drugs. There was no mention of trauma or fever. He had difficulty walking and complained of diffuse muscular pain, without any decrease in muscle strength or sensory complaints. Laboratory tests showed leucocytes 12.88x109/L, ESR 29mm/h, CRP 257mg/L, CK 1372 U/L, AST 47U/L, ALT 19U/L, urea 27mg/dL and creatinine 0.85mg/dL. He started flucloxacilin and clindamycin without improvement. Magnetic resonance imaging identified bilaterally a signal change of presumable inflammatory etiology in subcutaneous and muscular tissue (rectus femoris and adductor muscles, pelvic cellular adipose planes and pubic bone). The ecographic and electromyographic findings supported the diagnosis of unspecific myositis. Infectious etiologies, toxics, auto-imunne and metabolic diseases were investigated. Because he lived in a rural area he was also investigated for leptospirosis. Leptospira DNA was positive in the urine. He completed doxycycline with favorable response.
Discussion: The diagnosis of leptospirosis was established late on the evolution and the identification in the immunologic phase suggests a late consequence of the infection by this agent. The association between myositis and leptospirosis can result in a severe and atypical course of the disease. This case emphasizes the non-icteric forms which are often non-specific and may be missed by physicians.

Palavras Chave: leptospirosis, myositis