Atypical case of Lyme carditis in Florida girl

Atypical case of Lyme carditis in Florida girl

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On this case report, “A Uncommon Presentation of Lyme Illness in an Immunocompromised Affected person,” Basile and colleagues spotlight atypical cardiac manifestations attributable to Lyme disease and the challenges in diagnosing Lyme carditis in immunocompromised sufferers. [1]

In keeping with the authors, this affected person offered with myocarditis-predominant Lyme carditis with out cardiac conduction abnormalities – an uncommon presentation provided that 90% of Lyme carditis instances contain conduction abnormalities.

A 57-year-old girl, who was immunocompromised and dwelling in Florida, was admitted to the hospital for acute coronary heart failure with decreased ejection fraction.

Her signs included “subacute arthralgias, shortness of breath, bilateral decrease extremity swelling, exertional chest ache, dyspnea on exertion, a productive cough, subjective fevers, and unilateral imaginative and prescient loss,” the authors state.

The lady had eliminated an engorged tick one month previous to the onset of signs and had reportedly had an erythematous (EM) rash on the web site of the tick chew.

“The indicators and signs subsequently developed inside one to a few weeks after removing of the tick.”

The lady had an in depth medical historical past which included human immunodeficiency virus (HIV), tuberculosis, prior injection drug use, bipolar dysfunction, power obstructive pulmonary illness, sort 2 diabetes mellitus, hypertension, and atrial fibrillation/flutter with earlier cardioversion.

In keeping with the authors, chest X-rays confirmed pulmonary vascular congestion, cephalization of vasculature, and bilateral infiltrates – in line with pulmonary edema.

Testing for Lyme disease was optimistic by Western blot with positivity on 3 Borrelia-specific bands (41 kDa, 23 kDa, and 39 kDa).

“The 39 kDa band has the very best correlation with early-stage Lyme disease and is subsequently probably the most particular of the panel for B. burgdorferi an infection,” the authors level out.

Moreover, an EKG revealed acute remoted systolic coronary heart failure with none cardiac conduction system abnormalities.

“Given the constellation of signs – panuveitis, joint ache, unspecified rashes, new coronary heart failure, and optimistic Lyme serologies – the prognosis of Lyme carditis was made.”

The lady was handled efficiently with doxycycline.

“On the primary day of therapy,” the authors state, “the affected person skilled elevated erythema of her extremities with generalized pruritus, subjective fever, and fatigue in line with a Jarisch-Herxheimer response.” However her signs improved after 48 hours.

“One uncommon and reversible etiology of acute-onset congestive coronary heart failure is Borrelia burgdorferi an infection.”

This case is exclusive:

  • “There are just a few reported instances of Lyme carditis-associated coronary heart failure with out conduction abnormalities.” The vast majority of instances current with conduction abnormalities.
  • The affected person offered with a number of nonspecific findings within the setting of uncontrolled HIV.
  • The lady was a resident of Florida and had not just lately travelled out-of-state. Lyme disease is usually related to areas within the northeastern United States.
References:
  1. Basile E J, Smoot M, Hanna M E, et al. (April 19, 2024) A Uncommon Presentation of Lyme Illness in an Immunocompromised Affected person. Cureus 16(4): e58605. doi:10.7759/cureus.58605



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