Can Lyme Disease Cause Pericarditis? Symptoms, Cases and Treatment

Lyme disease can rarely cause pericarditis and chest pain
Fluid may accumulate in the sac surrounding the heart
Prompt recognition and treatment can improve outcomes

Can Lyme disease cause pericarditis? Yes. Although uncommon, Lyme disease can inflame the pericardium, the thin sac surrounding the heart. Patients may develop sharp chest pain, shortness of breath, and palpitations. In rare cases, inflammation may also lead to a pericardial effusion, commonly described as fluid around the heart.

Because early Lyme antibody testing may be negative, clinicians often rely on the patient’s history, physical examination, electrocardiogram (EKG), and the presence of erythema migrans when deciding whether to begin treatment.

Lyme-associated pericarditis differs from the more common form of Lyme carditis, which typically affects the heart’s electrical conduction system and may cause atrioventricular (AV) block. Although both are cardiac manifestations of Lyme disease, pericarditis primarily involves inflammation of the sac surrounding the heart and often presents with positional chest pain.

Some patients also have inflammation involving the heart muscle (myopericarditis), which may result in elevated cardiac biomarkers and rhythm abnormalities.

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

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

The pain was rated 8 out of 10, located in the center of his chest, and awakened him from sleep. It was accompanied by 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.

Rash provided an important diagnostic clue

One week before developing chest pain, the patient noticed 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, examination revealed “an erythematous oval rash in the right scapular and sub-scapular region with central clearing,” measuring approximately 5 × 3 inches, consistent with erythema migrans.

His EKG findings were consistent with acute pericarditis. Although his initial Lyme antibody test was negative, the combination of erythema migrans, compatible cardiac findings, and residence in a Lyme-endemic area strongly supported the diagnosis of Lyme-associated pericarditis. Because early serologic testing may be falsely negative, repeat serologic testing 2–6 weeks later was recommended if clinical suspicion remained high.¹

Pericarditis is inflammation of the thin, sac-like membrane surrounding the heart.² Typical symptoms include sharp chest pain that often worsens when lying flat or taking a deep breath and improves when leaning forward.

The patient was treated with ibuprofen, colchicine, and intravenous ceftriaxone. His palpitations and shortness of breath resolved completely, while his chest pain steadily improved.

Can Lyme disease cause fluid around the heart?

A 2025 case report described a 69-year-old woman who presented with chest pain, shortness of breath, and difficulty breathing while lying flat. Imaging revealed a large pericardial effusion with findings suggesting early tamponade physiology.³

Clinicians drained 450 mL of fluid from around her heart. Lyme antibody screening and an IgM immunoblot were positive after several other infectious, autoimmune, and metabolic explanations were investigated. She was treated with doxycycline, ibuprofen, and colchicine, and her symptoms resolved.

The report supports considering Lyme disease in the differential diagnosis of an otherwise unexplained pericardial effusion, particularly in an endemic region. However, Borrelia was not demonstrated directly in the pericardial fluid, so the case represents a clinical association rather than definitive proof of causation.

Early treatment is important

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

The authors also emphasize that cardiac involvement from Lyme disease can occasionally result in serious complications, including third-degree heart block. Therefore, a negative Lyme test early in the illness should not exclude the diagnosis when the clinical presentation strongly suggests Lyme disease.

While Lyme-associated pericarditis is uncommon, Lyme carditis is a more frequently recognized cardiac complication. Both conditions can present with chest pain and require prompt evaluation and treatment.

Another cardiac manifestation: Lyme carditis

A 45-year-old man was admitted to the hospital with left-sided chest pain. Four days earlier, he had developed 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 before admission, he noticed an erythematous rash on his shoulder.

“It had progressed from a small bug bite to a larger, 4 × 3 cm erythematous, painless, nonpruritic, targetoid bull’s-eye rash,” Michalski and colleagues reported.⁴

The patient was treated empirically with intravenous ceftriaxone for suspected Lyme carditis. 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 conclude.

Frequently Asked Questions

Can Lyme disease cause chest pain?

Yes. Lyme disease can cause chest pain when infection affects the heart, including Lyme-associated pericarditis and Lyme carditis. Because chest pain has many possible causes, prompt medical evaluation is essential.

Can Lyme disease cause fluid around the heart?

Yes, although it is rare. Inflammation of the pericardium may lead to a pericardial effusion, or fluid around the heart. A large effusion can interfere with the heart’s ability to pump normally and requires urgent evaluation.

Is Lyme pericarditis the same as Lyme carditis?

No. Lyme pericarditis affects the sac surrounding the heart. Lyme carditis more commonly affects the heart’s electrical conduction system and may cause atrioventricular block or other rhythm abnormalities.

Can Lyme disease cause heart palpitations?

Yes. Some patients with Lyme carditis or Lyme-associated pericarditis experience palpitations, dizziness, shortness of breath, or chest pain. These symptoms warrant prompt medical evaluation because cardiac involvement can occasionally become serious.

Clinical Takeaway

Lyme-associated pericarditis is an uncommon but important cardiac manifestation of Lyme disease. Patients may present with positional chest pain, shortness of breath, palpitations, or, rarely, fluid around the heart. Early Lyme antibody testing may remain negative, and pericardial effusion has many other possible causes that must be considered.

When the clinical presentation strongly suggests Lyme disease, treatment should not be delayed solely because early Lyme antibody testing is negative.

Related Articles

Lyme disease and the heart: When AV block progresses rapidly
Young adults most at risk for Lyme carditis
Anaplasmosis associated with cardiac complications

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention