Case Report

An Atypical Case of Rickettsial Spotted Fever Myocarditis Mimicking Weil’s Disease

Table 1

Summary of his laboratory investigation results.

InvestigationReference range

Day of illnessDay 4Day 5Day 6Day 7Day 8Day 9Day 10Day 11Day 13Day 14
White cell count (×109/l)4.0–10.0 × 109 (l)5.565.487.69 ⟶ 8.544.61 ⟶ 3.786.297.078.4410.86.78
Neutrophils (%)50–70%90.591.890.4 ⟶ 88.784.1 ⟶ 78.977.169.969.979.477.2
Lymphocytes (%)20–40% ⟶ 4.49.5 ⟶
Hemoglobin (g/dl)11–16%11.311.411.0 ⟶ 11.511.3 ⟶ 11.711.811.613.413.511.6
Hematocrit (%)37–54%33.53232.2 ⟶ 3332.2 ⟶ 33.1374036.1
Platelet count (×109/l)150–450 × 109 (l)30327 ⟶ 1211 ⟶ 173777120170257
Dengue IgM and IgG antibodiesBoth were negative
IgM against leptospiresNegative
Serum alanine transaminase1 (ALT) (U/l)7.0–28 U/l83.980.681.869.515939.636.231.5
Serum aspartate transaminase2 (AST) (U/l)13.0–31.0 U/l79.078.2103.885.610618.822.029.3
Serum C-reactive protein(CRP) (mg/l)0 (μmol/l)191.5198.6237.024.816.13.9
Serum creatinine (μmol/l)59–104 (μmol/l)148.9143.1163.4120.96657
Blood urea (mmol/l)2.80–7.20 (mmol/l)12.412.314.715.67.47
Serum sodium (mmol/l)133–148 (mmol/l)132132138
Serum potassium (mmol/l)3.5–5.3 (mmol/l)
Troponin I (ng/ml)<0.010.04
Urine full reportNo RBCs80–100
Blood cultureNo growth after 24 hrs
Chest X-rayBilateral patchy opacities
Serum protein (g/dl)6.4–8 (g/dl)5.28
Serum albumin (g/dl)3.2–5.4 (g/dl)3.0
Total bilirubin (μmol/l)3–21 (μmol/l)17.9
Bilirubin direct (μmol/l)1–7 (μmol/l)13.5
aPTT (sec)26–36 sec28.6
Throat swab for influenza A and BNegative
IgG against hantavirus (IFA)Negative
IgG against Rickettsia conorii (IFAT)Positive
IgM against Rickettsia conorii (IFAT)Positive

1Serum alanine transaminase (ALT) is also known as serum glutamic pyruvic transaminase (SGPT); 2serum aspartate transaminase (AST) is also known as serum glutamic oxaloacetic transaminase (SGOT).