Lyme-induced cardiac issues persist regardless of antibiotic remedy

Of their article, “An Uncommon Presentation of Lyme Carditis and Adenosine-Delicate Atrioventricular Block,” Alexandre and colleagues current the case of a 20-year-old feminine with Lyme disease and cardiac manifestations, who continued to expertise cardiac issues regardless of 4 weeks of antibiotic remedy. [1]

The younger girl was admitted to the emergency division with acute pleuritic chest ache and shortness of breath. (Pleuritic chest ache is characterised by sudden and intense sharp, stabbing, or burning ache within the chest when inhaling and exhaling.)

The lady exhibited solely delicate tachycardia (100/min). Nevertheless, “Contemplating the suspicion of acute myocarditis, the affected person was admitted to an intensive cardiac care unit,” the authors state.

Throughout hospitalization, cardiac monitoring revealed a number of asymptomatic episodes of paroxysmal AV block, together with second-degree Mobitz I AV block, second diploma AV block, and high-grade AV block.

Though there was no proof of tick publicity or pores and skin lesions, clinicians ordered testing for Lyme disease, which was optimistic by Western blot. “… an IgM Western-Blot check was carried out, confirming positivity and up to date Borrelia spp. an infection.”

The affected person was recognized with Lyme disease with cardiac manifestations of high-grade AV block. She was handled with a 4-week course of IV ceftriaxone, which led to an entire decision of chest ache and shortness of breath.

Nevertheless, the AV conduction disturbance continued after 4 weeks of antibiotic remedy. And subsequently, the girl was given an alternate prognosis of extrinsic idiopathic paroxysmal AV block (“adenosine-sensitive AV block”).

This could possibly be a particularly uncommon course of Lyme carditis, or the affected person might have had asymptomatic AV conduction issues that surfaced when she developed Lyme disease, in line with the authors.

“The affected person was began on theophylline 400 mg twice every day, and after one week of remedy, the Holter monitoring demonstrated a big discount in AV conduction disturbances,” the authors state.

At her 18-month follow-up appointment, the girl continued to have fewer AV conduction disturbances, no cardiac complaints, and no want for a everlasting pacemaker.

Authors conclude:

“This case illustrates a difficult state of affairs of [Lyme carditis] with excessive grade AV block, which persevered after acceptable antibiotic remedy and had key options supporting the prognosis of extrinsic idiopathic paroxysmal AV block (‘adenosine delicate AV block’).”