Lyme carditis presents without typical Lyme disease symptoms

A case report entitled “An Atypical Case of Lyme Disease Presenting With Lyme Carditis,” by Najam et al. demonstrates the importance of considering Lyme disease in patients who present with signs and symptoms of AV block and no other manifestations of Lyme disease. [1]

The authors describe a 70-year-old male who presented to the hospital without any typical Lyme disease symptoms, but exhibited generalized symptoms of progressive orthopnea and dyspnea on exertion.

The man had a medical history of hypertension and calcific aortic stenosis. His lab results were “significant for an increased erythrocyte sedimentation rate of 136, white blood cell count of 16.6, hemoglobin of 9.3, creatinine of 2.6, and normal liver enzymes. Troponins were negative but his brain natriuretic peptide was elevated at 877. His admitting EKG was significant for bradycardia with a heart rate in the mid-40s and a first-degree AV block.”

“We report a case of a 70-year-old male with Lyme disease presenting with a second-degree, Mobitz type 1 AV block.”

Clinicians considered his symptoms possibly due to anemia, progressive kidney disease, possible congestive heart failure exacerbation, worsening aortic stenosis, and/or pneumonia.

“Due to the prevalence of Lyme disease in the northeast and the patient’s symptomatology, a tick panel was ordered which came back positive for Lyme,” the authors wrote.

The patients were treated with IV Rocephin and oral doxycycline. He had a complete resolution of symptoms with a normal sinus rhythm without AV block.

“This incidence shows the importance of having a Lyme disease diagnosis when regionally appropriate for patients who may present with no other signs or symptoms other than an AV block.”

The authors suggest, “In highly endemic areas such as the northeast and Midwest United States, early recognition and treatment of Lyme disease is important for the prevention of long-term complications of disseminated infection.”