First reported case of Lyme carditis in Southwest Michigan

Abstract

Lyme disease is the most common tick-borne infection found in the eastern United States. In recent years, it has become an emergent Michigan public health concern. Lyme carditis is a recognized rare complication which is classically characterized by rapidly fluctuating degrees of heart block. In severe cases, or if inappropriately treated, Lyme carditis can also result in profound bradycardia, perimyocarditis, and sudden cardiac death. This report describes the first documented case of third degree heart block associated with Lyme carditis to occur in Michigan. This is a retrospective case report of a patient evaluated and treated for Lyme carditis in Southwest Michigan in July, 2016. All information was obtained from either the patient or his electronic medical record. Despite initial misdiagnosis and inappropriate management, this patient ultimately received more appropriate medical therapy within 24 hours of first presentation. After eight days of high dose intravenous Ceftriaxone and supportive care, and more than two weeks of oral Doxycycline, the patient's symptoms resolved and the disease was treated to resolution. Neither permanent nor temporary pacing was needed during/after the course of treatment. When correctly identified, Lyme disease and Lyme carditis can be easily treated. Although this patient's history was without reported tick bite or exposure to a known host for Lyme disease, the authors believe that the patient's history and physical exam was definitive enough to warrant the start of IV therapy with telemetry monitoring upon first presentation. The fact that the condition was not first diagnosed by providers indicates a potential gap in medical knowledge and awareness that should be addressed in clinical practice. The authors consider this case a harbinger of the emerging disease of Lyme carditis. Physical exam and EKG findings should guide clinicians' therapeutic approaches. Although treatment with appropriate antibiotics is typically curative, therapeutic delays can lead to deadly results.

Keywords: heart block; lyme carditis; lyme disease; tick-borne pathogens.

Figure 1:. Michigan Lyme Disease Incidence Rates (2002 – 2015).

Figure 2:. Anterior left hip and groin, 26cm. erythematous rash with central clearing.