First reported case of Lyme carditis in Southwest Michigan

Nicholas M Frazier,Richard W Douce

doi:10.51894/001c.5933

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.

Highlights

Lyme carditis is a rare complication of Lyme disease occurring in about 1% of cases.[1]
Cases of severe conduction abnormalities have been documented in top endemic areas, this case represents the first published account of complete heart block related to Lyme infection occurring in Michigan
Patients with significant new conduction abnormalities and suspected Lyme infection should be admitted for IV antibiotics and telemetry monitoring.[10]

Summary

INTRODUCTION

Lyme carditis is a rare complication of Lyme disease occurring in about 1% of cases.[1]. The northward expansion of the primary vector (or organisms responsible for transmission) for Lyme disease, the tick Ixodes scapularis,[9] as well as the possible emergence of a new tick species carrying Lyme, are possible contributors Despite this increased incidence, the authors believe this is the first published account of Lyme carditis in Michigan resulting in complete heart block. The authors believe this is the first published account of Lyme carditis in Michigan resulting in complete heart block This patient was a 36-year-old Caucasian male who first presented to an emergency department (ED) at a small community hospital a week after visiting Michigan’s upper peninsula. Western Blot testing from the patient’s original ED visit resulted demonstrating positive IgM (p41 and p23) and IgG (p18, p23, p39, p41, p45, and p66) bands In light of these findings and a largely negative cardiac work-up, a diagnosis of Lyme carditis was made. The patient was instructed to finish the remaining course of oral antibiotics and make aggressive lifestyle changes to decrease his underlying cardiac risk factors

DISCUSSION

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CONCLUSION

CONFLICT OF INTEREST