Lyme Pericarditis With Negative Test Results: Two Cases

Chest pain may be the first sign of Lyme disease
Early Lyme tests can be negative
Prompt treatment is critical to prevent complications

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

Case 1: Chest Pain With Classic Pericarditis Features

The patient presented to the emergency department with severe central chest pain (8/10), shortness of breath, and palpitations.

The pain worsened when lying down and with deep breathing—but improved when leaning forward, a classic feature of pericarditis.

One week earlier, he had noticed a rash on his back. Although he did not recall a tick bite, he lived in a wooded region of eastern Pennsylvania. :contentReference[oaicite:0]{index=0}

• EKG findings were consistent with pericarditis
• Lyme serology was initially negative
• Clinical diagnosis of Lyme pericarditis was made

The patient was treated with ibuprofen, colchicine, and intravenous ceftriaxone, with resolution of palpitations and shortness of breath and improvement in chest pain.

Case 2: Lyme Carditis Mimicking Cardiac Ischemia

A 45-year-old man presented with left-sided chest pain after several days of fever, chills, muscle aches, and headache.

He had been hunting three weeks prior and noted an erythema migrans rash on his shoulder one week before admission.

The rash progressed into a classic bull’s-eye lesion.

He was treated empirically for Lyme carditis with intravenous ceftriaxone, and his symptoms resolved.

Lyme Disease and the Heart

Lyme disease can affect the heart in several ways, including:

• Pericarditis (inflammation around the heart)
• Myocarditis
• Conduction abnormalities, including AV block

These cardiac features are part of the broader spectrum described in our Lyme heart symptoms guide.

Why Diagnosis Is Often Missed

Cardiac Lyme disease can be overlooked because:

• Chest pain is often attributed to cardiac ischemia or viral illness
• Patients may not recall a tick bite
• Early Lyme serology may be negative

These challenges are discussed in our Lyme test accuracy guide.

Why This Matters

Lyme pericarditis and carditis can lead to serious complications, including high-degree heart block and, in rare cases, death.

When patients present with chest pain, rash, and exposure risk, Lyme disease should be considered—even if initial tests are negative.

Start here: Lyme disease symptoms guide

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