Fatal Lyme Carditis in a Teen With Negative Test Results
Healthy teen with nonspecific symptoms
Initial Lyme tests were negative
Autopsy revealed fatal Lyme carditis
by Daniel J. Cameron, MD, MPH
This Inside Lyme case study describes a 17-year-old young man who died from Lyme carditis despite negative testing during his illness. :contentReference[oaicite:0]{index=0}
His case highlights a critical challenge: Lyme disease may not always be detected by standard laboratory tests—especially early in the course of illness.
A Typical Beginning—With Atypical Consequences
The patient was a healthy high school student who had recently returned from a summer camp in Rhode Island, an area endemic for Lyme disease.
He developed symptoms over several weeks, including:
- Fever and malaise
- Sore throat and cough
- Headaches and body aches
- Gastrointestinal symptoms
- Lightheadedness and photophobia
These symptoms are commonly described in Lyme disease symptoms, yet they were initially attributed to a viral illness.
Negative Testing Delayed Recognition
Initial testing for Lyme disease, strep, and anaplasmosis was negative.
Despite ongoing symptoms, no alternative diagnosis was made.
Approximately 12 days after his medical visits, he was found unresponsive at home and died shortly thereafter.
Autopsy Findings Confirm Lyme Disease
Autopsy revealed an enlarged heart consistent with Lyme carditis.
Laboratory testing identified Borrelia spirochetes in multiple tissues, including:
- Myocardial tissue
- Liver
- Lung
- Brain
Polymerase chain reaction (PCR) and immunohistochemistry confirmed the presence of the Lyme organism.
Notably, Lyme serologic testing that had been negative during life was positive postmortem.
Lyme Carditis Can Be Fatal
Lyme carditis affects the electrical conduction system of the heart and can lead to life-threatening arrhythmias.
These cardiac complications are discussed in our Lyme heart symptoms guide, where symptoms may progress rapidly.
Why This Case Matters
This case underscores two critical lessons:
- Lyme carditis, while uncommon, can be fatal
- Negative laboratory testing does not rule out Lyme disease
These challenges are part of a broader issue discussed in our Lyme test accuracy guide, where early and atypical cases may be missed.
When patients present with compatible symptoms and exposure risk, clinical judgment should guide decision making—not laboratory results alone.
Clinical Perspective
The patient lived in an endemic region and had a clear exposure history along with evolving symptoms consistent with Lyme disease.
Earlier clinical recognition and treatment may have altered the outcome.
This case highlights the importance of recognizing Lyme disease based on clinical patterns—particularly when testing is inconclusive.
Related Articles:
9 cases of children with Lyme neuroborreliosis
References:
- Yoon EC, et al. Fatal Lyme carditis in a 17-year-old male. Cardiovasc Pathol. 2015.
- Poughkeepsie Journal case report. View report
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
You were asked what treatment might have been effective. You do not seem to have answered that question
I typically use clinical judgment if the tests are negative or pending. The authors of the case came to the same conclusion. I often start with oral doxycycline but there are other treatments available depending on the case. I have also advised consultations, emergency room visits, hospitalizations and consultations as needed. I have also also added treatment for Babesia if needed.
I’ve been suffering from what I’m sure is Lymes for approximately 10 years. Testing negative twice is so frustrating, I’m suffering from all the mentioned symptoms. I’ve been to every medical professional and specialist, to hear my bloodwork says I’m healthy. Now, heart irregularities are occurring. Cardiologist said my heart looks fine after a 2 minute EKG! I woke up in November to a torn retina. When preparing me for surgery they ask if I’ve had heart issues. There it was showing up! I just encouraged my husband to increase my life insurance policy! At 55 I don’t think I should be suffering this much. I’m simply convinced my medical profession is failing me! Why can’t I get help?
Why is the mainstream medical industry disregarding this disease, making it impossible for people to afford treatment as it is
not conventional enough to be covered by health insurance. How many more people need to be infected.before the system changes?
I believe I am suffering from this now. I’ve had problems with my heart on and off for like 15 years. I’m 55 and was diagnosed with Lyme almost 4 years ago but believe I’ve had Chronic Lyme for years. I would have to wear a heart monitor several times in past all showing I was having issues but had no idea why. I’m assuming the Lyme was the underlying cause. I have no local Lyme Literate Doctors ugh so frustrating
How frustrating. You should include a doctor who is familiar with the range of manifestations of Lyme disease. Call my office in New York at 914 666 4665 with any questions.
Hey im 18 years old and I was tested positive for Lyme disease they gave me antibiotics but there not helping me I still feel all those symptoms my stomach my heart and my brain slow
I am sorry to hear you are still ill. I have patients with tick borne illnesses that have done well with an different antibiotic approach. I also need to rule out other causes.