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Lyme Carditis: A Case Report and Review of Management.
Hosp Pharm. 2018 Jul; 53(4):263-265.HP

Abstract

Purpose:

A case report of a patient who presented with an acute onset, fluctuating atrioventricular (AV) block and was diagnosed with Lyme carditis is presented.

Summary:

A 55-year-old man with progressively worsening generalized malaise, flu-like symptoms, dyspnea on exertion, and near syncope was admitted with bradycardia (heart rate was between 20 and 30 beats per minute upon admission). He endorsed having several tick bites after which he developed erythema migrans on his arm and abdomen. An electrocardiogram (ECG) revealed a second-degree AV block, fluctuating between Mobitz type I and Mobitz type II heart block, with a P-R interval of 300 ms. A presumptive diagnosis of Lyme carditis was made based on a confirmed history of tick exposure, presence of erythema migrans, and AV block. The patient was started on ceftriaxone. On day 3 of hospitalization, patient's heart rate was between 50 and 60 beats per minute. A diagnosis of Lyme disease was confirmed based on serologic testing. A repeat ECG revealed a first-degree AV block with a P-R interval of 300 ms. On day 5 of hospitalization, a peripherally inserted central catheter line was placed and the patient was discharged to his home on a 28-day course of ceftriaxone. Patient's heart rate was 65 beats per minute on discharge day.

Conclusion:

Considering Lyme carditis as a differential diagnosis in patients with an AV block of an unknown etiology can result in a timely diagnosis and treatment of Lyme carditis.

Authors+Show Affiliations

University of Pittsburgh Medical Center Mercy, PA, USA.University of Pittsburgh Medical Center Mercy, PA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30038446

Citation

Muhammad, Sheheryar, and Robert J. Simonelli. "Lyme Carditis: a Case Report and Review of Management." Hospital Pharmacy, vol. 53, no. 4, 2018, pp. 263-265.
Muhammad S, Simonelli RJ. Lyme Carditis: A Case Report and Review of Management. Hosp Pharm. 2018;53(4):263-265.
Muhammad, S., & Simonelli, R. J. (2018). Lyme Carditis: A Case Report and Review of Management. Hospital Pharmacy, 53(4), 263-265. https://doi.org/10.1177/0018578717749927
Muhammad S, Simonelli RJ. Lyme Carditis: a Case Report and Review of Management. Hosp Pharm. 2018;53(4):263-265. PubMed PMID: 30038446.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lyme Carditis: A Case Report and Review of Management. AU - Muhammad,Sheheryar, AU - Simonelli,Robert J, Y1 - 2018/01/02/ PY - 2018/7/25/entrez PY - 2018/7/25/pubmed PY - 2018/7/25/medline KW - cardiac agents KW - cardiovascular KW - critical care KW - infectious diseases SP - 263 EP - 265 JF - Hospital pharmacy JO - Hosp Pharm VL - 53 IS - 4 N2 - Purpose: A case report of a patient who presented with an acute onset, fluctuating atrioventricular (AV) block and was diagnosed with Lyme carditis is presented. Summary: A 55-year-old man with progressively worsening generalized malaise, flu-like symptoms, dyspnea on exertion, and near syncope was admitted with bradycardia (heart rate was between 20 and 30 beats per minute upon admission). He endorsed having several tick bites after which he developed erythema migrans on his arm and abdomen. An electrocardiogram (ECG) revealed a second-degree AV block, fluctuating between Mobitz type I and Mobitz type II heart block, with a P-R interval of 300 ms. A presumptive diagnosis of Lyme carditis was made based on a confirmed history of tick exposure, presence of erythema migrans, and AV block. The patient was started on ceftriaxone. On day 3 of hospitalization, patient's heart rate was between 50 and 60 beats per minute. A diagnosis of Lyme disease was confirmed based on serologic testing. A repeat ECG revealed a first-degree AV block with a P-R interval of 300 ms. On day 5 of hospitalization, a peripherally inserted central catheter line was placed and the patient was discharged to his home on a 28-day course of ceftriaxone. Patient's heart rate was 65 beats per minute on discharge day. Conclusion: Considering Lyme carditis as a differential diagnosis in patients with an AV block of an unknown etiology can result in a timely diagnosis and treatment of Lyme carditis. SN - 0018-5787 UR - https://www.unboundmedicine.com/medline/citation/30038446/Lyme_Carditis:_A_Case_Report_and_Review_of_Management_ L2 - http://journals.sagepub.com/doi/full/10.1177/0018578717749927?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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