A case of leptospirosis with erythema nodosum and reactive arthritis during the first trimester of pregnancy
Leptospirosis is a zoonosis and occurs in endemic as well as epidemic forms in many parts of India. Manifestations may range from asymptomatic infection to fulminant fatal disease with myositis, conjunctivitis, hepatic, renal, cardiac and neurological involvement and hemorrhagic manifestations. A 30 years old lady in her first trimester of gestation presented with multiple painful erythematous swellings over the front of legs, swelling and pain of left ankle joint for 1 week and fever for 3 days. On evaluation she had erythema nodosum over the shine of both tibia and reactive arthritis of left ankle joint. Leptospira serology for Immunoglobulin M was positive. The patient was started on intravenous ceftriaxone 1 gm twice daily. After 7 days of treatment erythema nodosum and reactive arthritis subsided. Erythema nodsum and reactive arthritis which are rare manifestations of leptospirosis have occurred together in a patient during her first trimester of pregnancy makes this case worth presenting.
2. Bal AM. Unusual clinical manifestations of leptospirosis. J Postgrad Med. 2005;51:179-83.
3.Shivakumar S,Shareek PS. Diagnosis of Leptospirosis utilizing modified Faineâ€™s criteria.J Assoc Physician India 2004;52:678-9.
4.Pappas G, Akritidis N, Christou L, Mastora M, Tsianos E. Unusual causes of reactive arthritis: Leptospira and Coxiella burnetii. Clin Rheumatol. 2003 Oct;22(4-5):343-6.
url - www.ncbi.nlm.nih.gov/pubmed/14576997
5. J M Buckler . Leptospirosis presenting with erythema nodosum. Arch Dis Child. 1977 May; 52(5): 418â€“419.
url- www.ncbi.nlm.nih.gov â€º Arch Dis Child â€º v.52(5); May 1977
6.Gochenour W.S., Smadel J.E, Jackson E.B, Evans L.B, and Yager R.H. Leptospirosis etiology of Fort Bragg fever. Public Health Reports (Washington).1952; 67:811-813.