May 2019

An active professional sportsman was admitted to our hospital with atrio-ventricular conduction disturbances. Purpose of admission was to insert a definitive pacemaker.

During recording of the symptoms and patient history, the patient mentioned a tick-bite on the neck, followed by the only symptom of atrio-ventricular conduction disturbances, four months later.

Serological tests came back negative for Lyme borreliosis, however, the clinical diagnosis of carditis borreliosa lymei monosymptomatica was made.

The diagnosis was supported only by detecting Borrelia spirochetes under a dark-field microscope. Samples were stored in a serum bank.

Treatment for Lyme borreliosis was started based on the clinical diagnosis, and the status of the patient was regularly monitored by laboratory tests. Symptoms improved, and result of serology came back positive on one occasion during treatment, confirming the clinical diagnosis. (N.B.: the serological finding may be attributed to the immune reaction to the disintegrating spirochetes)

A combined, high-dose, 8-week antibiotic therapy resulted in complete healing, no pacemaker had to be inserted.

At 18-month follow-up the patient was allowed to continue professional sports, he is in the first league. His follow-up for Lyme borreliosis is continued.

Dr Stef, Györgyi *,  Dr Bózsik, Béla Pál **,  Dr Forster, Tamás, Dr Jebelovszki, Éva,  Dr Thury, Attila, Prof. Dr. Csanády, Miklós  * Heart Clinic Balatonfüred   ** Lyme Borreliosis Foundation Budapest  Szent-Györgyi Albert Medical University Szeged, Department of Cardiology, 2nd Clinic for Internal Medicine, Budapest

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**Comment**

A number of important findings:

  1. the only symptom was a heart conduction issue
  2. standard testing was negative
  3. this case would have been missed if it weren’t for a clinical diagnosis
  4. dark field microscopy is much better at revealing Lyme disease
  5. after treatment was started (which served as a provoking agent) serology became positive
  6. a combined, high-dose, antibiotic therapy bypassed the need for a pacemaker
  7. they are smart enough to have lengthy followup as they understand the persistent nature of the organism.
  8. we know of this case thanks to the doctors who wrote about it.  How many more cases exist that aren’t on record?