Lyme Myocarditis Without Typical Lyme Disease Signs
NO RASH OR TICK BITE?
CAN LYME MYOCARDITIS
BE MISSED?
A 37-year-old man developed Lyme myocarditis without a rash, tick bite, or other typical signs of Lyme disease.
The patient resided in Germany and had been receiving immunosuppressive treatment for microscopic polyangiitis (MPA).
He presented to the emergency department with fatigue, palpitations, and shortness of breath that had worsened over one week.
The patient was “severely dyspnoeic (New York Heart Association IV), afebrile, and tachycardic (heart rate of 123/min) with blood pressure of 95/55 mmHg (without inotropic support),” the authors wrote.
Echocardiography and cardiac magnetic resonance imaging revealed a severely reduced left ventricular ejection fraction (LVEF) with global hypokinesia.
Diagnosis of Lyme Myocarditis
Biopsy of the left ventricle revealed lymphocytic myocarditis consistent with Lyme carditis.
“Nested PCR revealed the presence of Borrelia DNA in the endomyocardial biopsy,” the authors wrote. “Direct sequencing confirmed Borrelia afzelii.”
This case highlights how Lyme myocarditis may present without typical Lyme symptoms, making diagnosis more challenging.
Limitations of Standard Testing
The authors noted that cardiac magnetic resonance imaging and blood ELISA testing were neither sufficiently informative nor specific, particularly for cardiac involvement.
This case underscores the limitations of non-invasive testing in diagnosing Lyme myocarditis.
Treatment and Outcome
The patient was treated with intravenous ceftriaxone followed by oral doxycycline.
Repeat endomyocardial biopsy several months later showed marked regression of cardiac inflammation and absence of Borrelia DNA.
This clinical improvement highlights the potential for recovery with appropriate antibiotic therapy.
Why This Case Matters
The authors concluded that a severely reduced left ventricular ejection fraction can be the primary manifestation of Lyme disease—even in the absence of typical systemic findings.
This case emphasizes the importance of considering Lyme disease in patients with unexplained myocarditis, particularly when standard diagnostic tests are inconclusive.
Related Articles:
Lyme carditis causes heart block in 26-year-old man
Temporary pacemaker effective in acute Lyme carditis patient with severe heart block
First case of reversible complete heart block due to Lyme disease reported in Canada
References:
- Schroeter MR, Klingel K, Korsten P, Hasenfuß G. Fulminant Lyme myocarditis without any other signs of Lyme disease in a 37-year-old male patient with microscopic polyangiitis-a case report. Eur Heart J Case Rep. 2022;6(3):ytac062. Published 2022 Feb 9. doi:10.1093/ehjcr/ytac062
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
