Diagnostic challenges in treating patient with cardiogenic shock caused by Lyme disease

    Authors

    Abstract

    **Introduction**: Lyme disease is a multisystem disease caused by infection with Borelia burgdoferi and spread by a tick bite. Even though it most commonly affects the skin, joints and nervous system, it can rarely cause Lyme carditis. (1) In Europe, cardiac involvement as a complication of Lyme disease occurs in up to 4%, with 3-fold higher male predominance. The most common clinical feature of Lyme carditis is atrioventricular (AV) conduction block of varying severity but may also include decreased cardiac contractility due to myopericarditis. These cardiac features typically occur one to two months after the onset of infection. We present a case report of a patient with cardiogenic shock and later confirmed Lyme disease. **Case report**: 71-year-old patient, with two-month long history of progressive exertional dyspnea, was hospitalized in coronary intensive care unit due to cardiogenic shock with severely impaired left ventricular function (EF 15%; in 2016 EF was 56%) and developed signs of type 1 cardiorenal syndrome. The patient had no chest pain, no electrocardiographic signs of ischemia nor elevation of cardiac biomarkers. The patient initially required inotropic support that with other standard treatment for acute heart failure gradually led to clinical and echocardiographic improvement (EF 31%). The patient then underwent coronary angiography that showed diseased left anterior descending coronary artery that was treated with two stents. Since acute myocardial infarction was not the cause of acute heart failure, other possible causes were investigated, primarily myocarditis. More detailed clinical history revealed tick bite about two months prior to hospital admission, which rose suspicion of Lyme carditis, even though the patient had no registered AV conduction disturbances. An enzyme-linked immunosorbent assay and Western blot both came seropositive for Borelia burgdoferi antibodies, confirming the diagnosis. **Conclusion**: Lyme carditis is a rare manifestation of boreliosis with possible lethal complications. Therefore, detailed clinical history and physical examination are crucial for making correct diagnosis and giving the right treatment.

    Keywords

    Lyme disease, cardiogenic shock, myocarditis

    DOI

    https://doi.org/10.15836/ccar2018.373

    Literature

    1. Scheffold N, Herkommer B, Kandolf R, May AE. Lyme carditis--diagnosis, treatment and prognosis. Dtsch Arztebl Int. 2015 Mar 20;112(12):202–8. https://doi.org/10.3238/arztebl.2015.0202
    Cardiologia Croatica
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    Diagnostic challenges in treating patient with cardiogenic shock caused by Lyme disease

    Extended Abstract
    Issue11-12
    Published
    Pages373
    PDF via DOIhttps://doi.org/10.15836/ccar2018.373
    Lyme disease
    cardiogenic shock
    myocarditis

    Authors

    Vera Slatinski*ORCIDKlinička bolnica „Sveti Duh“, Zagreb, Hrvatska
    Dario GulinORCIDKlinička bolnica „Sveti Duh“, Zagreb, Hrvatska
    Zrinka PlaninićORCIDKlinička bolnica „Sveti Duh“, Zagreb, Hrvatska
    Ante PašalićORCIDKlinička bolnica „Sveti Duh“, Zagreb, Hrvatska
    Tea FriščićORCIDKlinička bolnica „Sveti Duh“, Zagreb, Hrvatska
    Marko PerčićORCIDKlinička bolnica „Sveti Duh“, Zagreb, Hrvatska
    Jasna Čerkez HabekORCIDKlinička bolnica „Sveti Duh“, Zagreb, Hrvatska
    Jozica ŠikićORCIDKlinička bolnica „Sveti Duh“, Zagreb, Hrvatska

    *Correspondence email: vslatinski@kbsd.hr

    Abstract

    **Introduction**: Lyme disease is a multisystem disease caused by infection with Borelia burgdoferi and spread by a tick bite. Even though it most commonly affects the skin, joints and nervous system, it can rarely cause Lyme carditis. (1) In Europe, cardiac involvement as a complication of Lyme disease occurs in up to 4%, with 3-fold higher male predominance. The most common clinical feature of Lyme carditis is atrioventricular (AV) conduction block of varying severity but may also include decreased cardiac contractility due to myopericarditis. These cardiac features typically occur one to two months after the onset of infection. We present a case report of a patient with cardiogenic shock and later confirmed Lyme disease. **Case report**: 71-year-old patient, with two-month long history of progressive exertional dyspnea, was hospitalized in coronary intensive care unit due to cardiogenic shock with severely impaired left ventricular function (EF 15%; in 2016 EF was 56%) and developed signs of type 1 cardiorenal syndrome. The patient had no chest pain, no electrocardiographic signs of ischemia nor elevation of cardiac biomarkers. The patient initially required inotropic support that with other standard treatment for acute heart failure gradually led to clinical and echocardiographic improvement (EF 31%). The patient then underwent coronary angiography that showed diseased left anterior descending coronary artery that was treated with two stents. Since acute myocardial infarction was not the cause of acute heart failure, other possible causes were investigated, primarily myocarditis. More detailed clinical history revealed tick bite about two months prior to hospital admission, which rose suspicion of Lyme carditis, even though the patient had no registered AV conduction disturbances. An enzyme-linked immunosorbent assay and Western blot both came seropositive for Borelia burgdoferi antibodies, confirming the diagnosis. **Conclusion**: Lyme carditis is a rare manifestation of boreliosis with possible lethal complications. Therefore, detailed clinical history and physical examination are crucial for making correct diagnosis and giving the right treatment.

    Literature

    1. 1.
      Scheffold N, Herkommer B, Kandolf R, May AE. Lyme carditis--diagnosis, treatment and prognosis. Dtsch Arztebl Int. 2015 Mar 20;112(12):202–8.DOI