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Case Reports
. 2021 Jun 10:25:e01179.
doi: 10.1016/j.idcr.2021.e01179. eCollection 2021.

A curious case of Lyme carditis in an urban hospital

Shantel Brissett  1 , Khaing T Myint  2 , Yanira Lopez  3 , Farbod Raiszadeh  4 , Vel Sivapalan  2 , Damian Kurian  4
Affiliations
Case Reports

A curious case of Lyme carditis in an urban hospital

Shantel Brissett et al. IDCases. .

Abstract

Lyme carditis (LC), a manifestation of early disseminated Lyme disease, most commonly presents with cardiac conduction abnormalities. It is a transient condition with good prognosis but in extremely rare cases may be life-threatening. We describe a 42-year-old man who presented with progressively worsening generalized weakness, presyncope and dyspnea on exertion for 2 weeks after sustaining a tick bite. He subsequently developed a 'bull's eye rash' on his flank 2 days before his presentation. He was found to have symptomatic third-degree AV conduction blockade with a ventricular escape rhythm resulting in a brief cardiac arrest. Intravenous (IV) ceftriaxone was commenced empirically and a temporary transvenous pacemaker was placed. In a few days he showed dramatic, rapid improvement; the pacemaker was removed, and the patient was discharged on oral doxycycline to complete a 24-day course. This case is unique due to its occurrence in an urban hospital where such cases are uncommon. Cardiac arrest, although brief in this case, is a rare occurrence. Lyme carditis was a surprise diagnosis in our hospital due to the patient's geographical dislocation during the COVID-19 pandemic.

Keywords: AV, atrioventricular; Cardiology; ECG, electrocardiogram; High-grade AV block; IV, intravenous; Infectious diseases; LC, Lyme carditis; LD, Lyme disease; Lyme carditis; MS, millisecond; Transvenous pacemaker.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
ECG on presentation showing third degree AVB with ventricular escape rhythm.
Fig. 2
Fig. 2
ECG post transvenous pacemaker placement.
Fig. 3
Fig. 3
ECG on Day 3 showing transition to first degree AVB with P-R interval 330 msec.
Fig. 4
Fig. 4
ECG on Day 4 showing first degree heart block with P-R interval <290 msec.
See this image and copyright information in PMC

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