Lyme carditis: Early occurrence and prolonged recovery

Highlights

• Atrioventricular block caused by Lyme carditis can occur as early as three days after a tick bite.

• Lyme carditis should be considered in patients with AV block, especially those living in an endemic area.

• Early recognition and appropriate antibiotic treatment is essential to achieve a favorable prognosis.

Abstract

Lyme carditis is an uncommon manifestation of early disseminated Lyme disease. This case illustrates a 66-year-old male with complaints of fatigue, myalgias, and fever after a tick bite 3 days earlier. A large erythema migrans was found on the chest wall. Initial electrocardiogram showed sinus rhythm with second degree 2:1 atrioventricular (AV) block, which progressed to intermittent complete AV block rapidly. He was treated with intravenous ceftriaxone. Over the course of 2-weeks of antibiotic therapy, the intermittent high-grade AV block improved slowly and progressively. This case highlights the importance of timely diagnosis and appropriate management to achieve a favorable prognosis.

Introduction

Lyme disease is a multisystem disease caused by infection with Borrelia burgdorferi, affecting approximate 300,000 cases annually in the United States [1]. The clinical course of Lyme disease can be generally categorized into three stages (early localized stage, early disseminated stage, and persisting late stage). Lyme carditis is a rare manifestation in early disseminated phase. It is estimated that 4%–10% of patients in the United States who have untreated Lyme disease develop carditis [2]. The most common manifestation of Lyme carditis is varying atrioventricular (AV) conduction block. Here, we describe an interesting case of a 66-year-old male with a very early occurrence of AV conduction abnormality together with characteristic erythema migrans (EM).