Acute Borrelia burgdorferi infection in pregnancy

Abstract

Introduction: There is a paucity of information regarding the potential complications and sequelae regarding intrauterine exposure to Borrelia burgderfori. Borrelia infection continues to be of increasing concern, with endemic regions now spanning the United States, and a continual increase in the number of documented cases of infection annually. Case Report: A 26-year-old gravida 1 para 0 who presented at 21 weeks 2 days gestational age to her primary care provider and was diagnosed and treated for a right knee Lyme monoarthritis. Antenatal course was complicated with fetal growth restriction and concern for a congenital cardiac malformation. The patient underwent induction of labor and delivered a viable male infant at 39 weeks. The patient had an uncomplicated postpartum course and was discharged home on postpartum day two. She followed up with her rheumatology providers at three months and showed improvement in her right knee Lyme monoarthritis. Her neonate underwent an echocardiogram following delivery which showed a small atrial septal defect, patent ductus arteriosus, patent foramen ovale, and a pericardial effusion. Repeat echocardiogram was performed at three months of age and showed resolution of those abnormalities and no evidence of any other cardiac abnormalities. The infant is currently meeting all expected developmental milestones. Conclusion: There remains a gap in knowledge regarding the potential adverse maternal, fetal, and neonatal outcomes that can result from acute infection with Borrelia burgdorferi. Given the potential for severe sequelae, providers must be aware of the appropriate treatment regimens for these patients during pregnancy, especially in endemic areas.