An Atypical Case of Rickettsial Spotted Fever Myocarditis Mimicking Weil’s Disease
Table 1
Summary of his laboratory investigation results.
Investigation
Reference range
Day of illness
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
Day 11
Day 13
Day 14
White cell count (×109/l)
4.0–10.0 × 109 (l)
5.56
5.48
7.69 ⟶ 8.54
4.61 ⟶ 3.78
6.29
7.07
8.44
10.8
6.78
Neutrophils (%)
50–70%
90.5
91.8
90.4 ⟶ 88.7
84.1 ⟶ 78.9
77.1
69.9
69.9
79.4
77.2
Lymphocytes (%)
20–40%
4.5
3.9
5.3 ⟶ 4.4
9.5 ⟶ 13.8
8.0
16.5
15.9
12.4
16
Hemoglobin (g/dl)
11–16%
11.3
11.4
11.0 ⟶ 11.5
11.3 ⟶ 11.7
11.8
11.6
13.4
13.5
11.6
Hematocrit (%)
37–54%
33.5
32
32.2 ⟶ 33
32.2 ⟶ 33.1
37
40
36.1
Platelet count (×109/l)
150–450 × 109 (l)
30
32
7 ⟶ 12
11 ⟶ 17
37
77
120
170
257
Dengue IgM and IgG antibodies
Both were negative
IgM against leptospires
Negative
Serum alanine transaminase1 (ALT) (U/l)
7.0–28 U/l
83.9
80.6
81.8
69.5
159
39.6
36.2
31.5
Serum aspartate transaminase2 (AST) (U/l)
13.0–31.0 U/l
79.0
78.2
103.8
85.6
106
18.8
22.0
29.3
Serum C-reactive protein(CRP) (mg/l)
0 (μmol/l)
191.5
198.6
237.0
24.8
16.1
3.9
Serum creatinine (μmol/l)
59–104 (μmol/l)
148.9
143.1
163.4
120.9
66
57
Blood urea (mmol/l)
2.80–7.20 (mmol/l)
12.4
12.3
14.7
15.6
7.47
Serum sodium (mmol/l)
133–148 (mmol/l)
132
132
138
Serum potassium (mmol/l)
3.5–5.3 (mmol/l)
4.8
3.0
3.5
Troponin I (ng/ml)
<0.01
0.04
Urine full report
No RBCs
80–100
RBCs
Blood culture
No growth after 24 hrs
Chest X-ray
Bilateral 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
INR
0.81
aPTT (sec)
26–36 sec
28.6
Throat swab for influenza A and B
Negative
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).
