Anaplasmosis associated with cardiac complications

Over the last several years, there has been a three-fold increase in the number of anaplasmosis cases in the United States. The tick-borne illness can be transmitted through the bite of an infected blacklegged (deer) tick and causes flu-like symptoms, similar to those seen in Lyme disease. Anaplasmosis has only rarely been associated with cardiac complications.

The article “Tick-Borne Myopericarditis with Positive Anaplasma, Lyme, and Epstein Barr Virus (EBV) Serology: A Case Report,” by Arshad and colleagues features a 61-year-old man, from New Jersey, who presented to the emergency department with fever, chills, myalgia, nausea, vomiting, and diarrhea.¹ He also had lightheadedness and shortness of breath. His symptoms had been ongoing for two weeks.

The man’s medical history included hypertension, hyperlipidemia, and coronary artery disease. “Further history-taking revealed a recent history of a tick found in his clothes.” He was subsequently treated successfully with doxycycline.

“This case highlights an uncommon presentation of carditis in acute Lyme and anaplasma infections with the associated false-positive serology of EBV.”

Positive test results later confirmed acute Lyme disease and anaplasma infections, along with a positive serology of Epstein Barr virus.

According to the authors, “Electrocardiography (EKG) was notable for tachycardia with global mild ST elevations throughout the EKG.” And, a mild troponin leakage was present, which progressed to septic shock and required vasopressor therapy.

“In this case, the most likely diagnosis is myopericarditis related to anaplasmosis. However, the presence of overlapping Lyme disease cannot be ascertained.”

Authors’ Takeaways:

• “In endemic regions as in the Northeastern United States, tick-borne carditis should always be included in the differential diagnosis.”
• “Lack of other clinical manifestations of Lyme disease including rash history should not prompt exclusion of Lyme disease from the differential diagnosis.”
• “Clinical presentation can be potentially fatal with cardiogenic shock. However, prompt initiation of antibiotic therapy, i.e. doxycycline usually results in rapid clinical improvement.”
• “The EBV serology can be falsely positive among those with acute Lyme disease.”