Madison Area Lyme Support Group

Background: Lyme disease is a tick-borne multisystem infection. The most common cardiac manifestation is an acute presentation of Lyme carditis, which often manifests as conduction disorder and rarely as myocarditis.

Case summary: We report the case of a 37-year-old male with a history of microscopic polyangiitis (blood vessel inflammation or vasculitis) receiving immunosuppressive therapy. He was admitted for severe dyspnoea secondary to acute heart failure. Echocardiography and cardiac magnetic resonance imaging indicated a severely reduced left ventricular ejection fraction (LVEF) with global hypokinesia. Coronary heart disease was excluded, and endomyocardial biopsies (EMB) were performed. The left ventricular EMB revealed a rare case of fulminant Lyme carditis with evidence of typical lymphocytic myocarditis. Borrelia afzelii-DNA was detected without any relevant atrioventricular blockage or systemic signs of Lyme disease. The patient had no clinically apparent tick-borne infection or self-reported history of a tick bite. Immunological testing revealed a positive ELISA and Immunoblot for anti-Borrelia immunoglobulin G antibodies. After specific intravenous antibiotic therapy and optimized medical therapy for heart failure, the LVEF recovered, and the patient could be discharged in an improved condition. Repeat EMB a few months later revealed a dramatic regression of the cardiac inflammation and absence of Borrelia DNA in the myocardium.

Discussion: A severely reduced LVEF can be the primary manifestation of Lyme disease even without typical systemic findings and can have a favourable prognosis with antibiotic treatment. A thorough workup for Lyme carditis is required in patients with unexplained heart failure, particularly with EMB, especially in immunosuppressed patients.

For more:

• https://madisonarealymesupportgroup.com/2021/06/01/lyme-carditis-2021-update/
• https://madisonarealymesupportgroup.com/2022/02/21/lyme-carditis-case/
• https://madisonarealymesupportgroup.com/2019/12/09/study-identifies-189-children-with-lyme-carditis/
• https://madisonarealymesupportgroup.com/2019/06/04/how-vector-borne-diseases-impact-heart-health/
• https://madisonarealymesupportgroup.com/2018/09/17/lyme-carditis-heart-block-other-complications-of-ld/
• https://madisonarealymesupportgroup.com/2021/12/06/lyme-can-affect-the-heart-in-complicated-ways/
• https://madisonarealymesupportgroup.com/2019/11/04/suspect-lyme-carditis-start-empiric-antibiotics-case-report-suggest-and-lyme-carditis-is-not-rare/
• https://madisonarealymesupportgroup.com/2020/02/27/which-treatment-guidelines-should-you-follow-for-lyme-carditis/