Fulminant Lyme myocarditis without any other signs of Lyme disease in a 37-year-old male patient with microscopic polyangiitis—a case report

2022 | journal article. A publication with affiliation to the University of Göttingen.

Jump to: Cite & Linked | Documents & Media | Details | Version history

Cite this publication

​Fulminant Lyme myocarditis without any other signs of Lyme disease in a 37-year-old male patient with microscopic polyangiitis—a case report​
Schroeter, M. R; Klingel, K.; Korsten, P. & Hasenfuß, G. ​ (2022) 
European Heart Journal - Case Reports6(3).​ DOI: https://doi.org/10.1093/ehjcr/ytac062 

Documents & Media

License

GRO License GRO License

Details

Authors
Schroeter, Marco R; Klingel, Karin; Korsten, Peter; Hasenfuß, Gerd 
Editors
De Potter, Tom; Vidal-Perez, Rafael; Nistor, Dan Octavian; Agarwal, Megha; Sunjaya, Antony Paulo
Abstract
Abstract 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 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.
Issue Date
2022
Journal
European Heart Journal - Case Reports 
eISSN
2514-2119
Language
English

Reference

Citations


Social Media