Lyme endocarditis in 68-year-old avid outdoorsman
“Lyme endocarditis can be a challenging diagnosis to make, given the rarity of cases, inability to grow the organism in culture, and serologic testing that does not clearly distinguish between current and prior infection,” according to Paim and colleagues from the Division of Infectious Diseases at Mayo Clinic. [1]
In their article published in The American Journal of Medicine, Paim and her team describe a 68-year-old male with progressive dyspnea and valve disease. His transesophageal echocardiogram revealed a mitral valve perforation with severe mitral valve insufficiency.
The mitral valve was repaired and aortic valve replaced. The patient was prescribed ceftriaxone and azithromycin along with diuretic therapy for presumed heart failure exacerbated by community-acquired pneumonia.
He was diagnosed with Borrelia burgdorferi, the causative agent of Lyme disease, using the molecular diagnostic test 16S rRNA PCR and sequencing. His blood and valve tissues were culture negative. Other infectious causes of endocarditis were ruled out.
The patient is an avid outdoorsman and reported having tick bites every year, including just a few weeks before he presented with severe mitral valve dysfunction.
[bctt tweet=”Heart problem or Lyme disease?” username=”DrDanielCameron”]
Serologic tests were positive by IgM and IgG Western Blot, consistent with both active and prior infection. The patient was successfully treated with 6 weeks of intravenous ceftriaxone.
Other studies have described cardiac manifestations of Lyme disease. According to a review by Paim et al., out of 84 patients with Lyme carditis:
• 69% reported palpitations
• 19% had conduction abnormalities
• 10% had myocarditis
• 5% had left ventricular systolic dysfunction
Seven cases suggestive of degenerative valve pathology have also been described but not as well characterized as this case.
The diagnosis of Lyme endocarditis is not easy. “The clinical patient manifestations of Lyme endocarditis are nonspecific and can be similar to other infectious and noninfectious systemic diseases,” writes Paim.
Fortunately, the doctors were able to diagnose the man with Lyme endocarditis and treat successfully. This case should encourage other doctors to include Lyme disease in their evaluation.
Related Articles:
Another cardiac manifestation of Lyme myocarditis
Lyme carditis causes complete heart block in 26-year-old man
When Lyme disease mimics a heart attack
References:
- Paim AC, Baddour LM, Pritt BS, Schuetz AN, Wilson JW. Lyme Endocarditis. Am J Med. 2018.
Gib Mitrad
12/13/2020 (4:00 pm)
I’m a 66 year old male. Had lyme disease. 3 years ago and was treated with doxycycline. Till now no problems. Had an EKG recently and diagnosed with afib and put on eliquis. After 10 days my ankle swelled up and pain when walking. Had an ultrasound and told I have vegetation on mitral valve. Will see heart doctors in January. I’m on doxycycline right now because I feel lyme is affecting my ankle. It’s that or the eliquis. What is your opinion
Dr. Daniel Cameron
12/14/2020 (7:32 am)
I would refer a patient with vegetations to the cardiologist now rather than January to look for endocarditis. Endocarditis can lead to valve failure. The swelling can come from heart failure of a calcium channel blocker.
Virginia Perejda
09/23/2020 (5:29 pm)
I’m not sure if this post is still active. In late June, 2020, I found 4 “poppy seed “sized ticks around my knee. I am not sure how long they were there , but very well attached. I removed them, cleaned the site, and forgot them until an oval 5 inch rash formed around the area. I was also noting pain in my knee, and my daily walks and gardening difficult. I went to see my internal medicine provider. He took a picture of the site, and called it Erythema Migrans. He gave me a prescription for 2 weeks of Amoxicillin 500 mg tid, as I am allergic to Doxy from childhood. He extended the script another 2 weeks, as I had trouble bearing weight on affected knee. I made an appointment with an internal Med doc that also does infectious disease. He told me I had received adequate antibiotics, and would clear eventually. A Lyme AB panel done while I was on ABX, showing 2 positive bands. A third band showed up on a repeat test 1 month later. Meanwhile, my knee swollen and hot. An x ray of knee and fib-tib normal(I am almost 68 and active.) B/c it is 3 months of knee issue, my infectious disease Doc has given me 4 more weeks of ABX. He did not change ABX, and feels it’s not Lyme. My heart sometimes races and pounds, my BP perfect. I hope this tick borne illness is not causing irreversible damage somewhere. I have enjoyed an active lifestyle up to this time. I am amazed in all the confusion on how to treat.
Dr. Daniel Cameron
09/24/2020 (7:47 am)
Doctors are divided on how to approach treatment. I have patients who have failed treatment. In some cases, it may be a co-infection that does not respond to amoxicillin. Give my office a call at 914 666 4665 if you have any questions.
Janet
01/16/2019 (3:11 am)
My daughter has Lyme Disease and has been battling it for 4 yrs. We have to see a holistic doctor out of state as that is the only real help we have found. 8 medical doctors in our area have ridiculed and mistreated, misdiagnosed and humiliated her. Tonight she has chest pains again, and I am worried about her heart. I cannot take her to the local ER because the last time she was there , out of breath with chest pains they just gave her an anti- anxiety and said that many teenage girls go to Lyme doctors who are actually just depressed. If she dies from Lyme in her heart, who in this country would even acknowledge the truth?
Sent from my iPhone
Dr. Daniel Cameron
01/16/2019 (1:36 pm)
It has to be difficult on your daughter. I am assuming that she had been evaluated by a cardiologist. I often seen adolescents who remain ill despite numerous evaluations. Mood issues are common in Lyme disease as a symptom and not the cause.
Sally Mitchell
05/10/2018 (11:04 pm)
About 3 years ago, my husband was feeling very sick and at night he would have such heavy night sweats that he used to sleep on beach towels to absorb the perspiration. He saw an internist, was put in the hospital for 4 days, was released and declared healthy. While in the hospital many tests were done and he also saw a urologist, a hematologist, and an infections disease doctor. He was tested for Lyme and it was negative. Not one of his doctors seem to know what we eventually found out, and that is there are 9 tick borne diseases only 3 of which have blood tests. I was desperate. Someone finally recommended Dr. Cameron. We went there with the huge file I had accumulated, he listened, took blood to send to the lab, and put him immediately on antibiotics for 6 weeks. He explained about the 9 tick borne diseases and had seen cases like my husband many times. Even after two weeks on the medicine, my husband was starting to feel better. By the end of the 6 week period, he was 95% recovered. The only reason I even found Dr. Cameron was because I was telling everyone I knew, or met, and even total strangers and finally my Bond broker told me about a Dr. his mother had used. I considered ourselves extraordinarly lucky to have found this man. And I am appalled at how none of the other doctors had a clue.