Case reports: Lyme disease infection causes carditis

In their article, “Lyme-Associated Pericarditis: A Case Report and Literature Review,” Ameer and colleagues describe an 18-year-old man who developed pericarditis due to Lyme disease.¹

The patient who had a medical history of asthma, irritable bowel syndrome, and obsessive-compulsive disorder presented to the emergency department with complaints of chest pain.

The pain was intense – 8 on a scale of 10 and located in the center of his chest. The pain woke him up from sleep and was associated with shortness of breath and palpitations.

“The pain worsened with lying down, while taking deep breaths, and coughing. Leaning forward, however, reduced the pain,” the authors state.

A week prior to the onset of his symptoms, the man reported having a rash on his back. Although he did not recall a tick bite, he lived in a heavily wooded area of eastern Pennsylvania.

According to the authors, “an examination revealed an erythematous oval rash in the right scapular and sub-scapular region with central clearing, measuring approximately 5 x 3 inches.”

The patient’s EKG findings were consistent with pericarditis. And although testing for Lyme disease was negative, the man was diagnosed with Lyme-induced pericarditis.

Pericarditis is swelling and irritation of the thin, saclike tissue surrounding the heart.²

His heart palpitations and shortness of breath resolved completely and his chest pain improved following treatment with ibuprofen, colchicine and intravenous ceftriaxone.

“In patients with symptoms suggestive of Lyme pericarditis, empiric treatment should be administered immediately, even before Lyme serology is processed,” the authors state.

Furthermore, they state, cardiac involvement due to Lyme disease can have fatal outcomes, including third-degree heart block. “A negative test in the initial phase of the disease cannot rule out the disease.”

Lyme disease causes carditis in 45-year-old man

A 45-year-old man was admitted to the hospital with left sided chest pain. Four days earlier, he developed a fever, muscle aches, neck and back stiffness, headache, chills, diaphoresis, and nausea.

The patient had been hunting three weeks before his symptoms began. One week prior to admission, he noticed an erythematous (EM) rash on his shoulder.

“It had progressed from a small bug bite to a larger, 4 × 3 cm erythematous, painless, nonpruritic, targetoid bull-eyes rash,” states Michalski et al.³

The man was treated empirically for Lyme carditis with IV ceftriaxone. His symptoms resolved following treatment.

“This case illustrates the importance of thorough history taking and extensive physical examination when assessing a case of possible acute myocardial infarction,” the authors state.