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Complete Heart Block as the Sole Presentation of Lyme Disease

Complete Heart Block as the Sole Presentation of Lyme Disease Abstract • We report a case of Lyme myocarditis presenting solely as complete heart block in a previously healthy 32-year-old white man. Indium cardiac antimyosin scan showed diffuse uptake (2 +, on a scale of 0 to 4+) during the acute phase of the illness. The electrocardiogram and the indium cardiac antimyosin scan were normal 6 weeks after completion of tetracycline and prednisone treatment. Lyme carditis should be considered in the differential diagnosis of complete heart block of unclear origins, even in patients presenting without other signs or symptoms suggestive of Lyme disease. (Arch Intern Med. 1989:149:1897-1898) References 1. Williamson PH, Calaba JJ. Lyme disease: a review of the literature . Semin Arthritis Rheum . 1984;23:229-234.Crossref 2. Steere A. The clinical spectrum and treatment of Lyme disease . Yale J Biol Med . 1984;57:453-461. 3. Zipes DP. Specific arrhythmias: diagnosis and treatment . In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine . 3rd ed. Philadelphia, Pa: WB Saunders Co: 1988:658-718. 4. Vlay SC. Complete heart block due to Lyme disease . N Engl J Med . 1986;315:1418. 5. Roznick JW, Braunstein DB, Walsh RL, et al. Lyme carditis: electrophysiologic and histopathologic study . Am J Med . 1986;81:923-927.Crossref 6. Marcus LC, Steere AC, Duray PH, Anderson AE, Mahoney EB. Fatal pancarditis in a patient with coexistent Lyme disease and babesiosis . Ann Intern Med . 1985;103:374-376.Crossref 7. Ebright JR, Soin JS, Manoli RS. Thegallium scan: problems and misuse in examination of patients with suspected infection . Arch Intern Med . 1982;142:246-254.Crossref 8. Rienzo RJ, Merel DE, Prager D, Barron L, Post R. Gallium avid Lyme myocarditis . Clin Nucl Med . 1987;12:475-476.Crossref 9. Khaw BA, Gold HK, Tasida T, et al. Scintigraphic quantification of myocardial necrosis in patients after intravenous injection of myosin specific antibody . Circulation . 1986;74:501-508.Crossref 10. Khaw BA, Fallon JT, Benner GA, Haber E. Specificity of localization of myosin specific antibody fragment in experimental myocardial infarction: histologic histochemical, anteradiographic and scintigraphic studies . Circulation . 1979;60:1527-1534.Crossref 11. O'Connell JB, Hendin RE, Robinson JA, Subramanian R, Scanlon PJ, Gunnar RM. Gallium-67 imaging in patients with dilated cardiomyopathy and biopsy-proven myocarditis . Circulation . 1984;70:58-62.Crossref 12. Weber H. Die Lyme-Berrelioso . Hautarzt . 1986;37:583-586. 13. Olson LJ, Okafor EC, Clements EC. Cardiac involvement in Lyme disease: manifestations and management . Mayo Clin Proc . 1986;61:746-749.Crossref 14. Steere AC, Malawista SE, Newman JH, Spieler PN, Bartenhagen NH. Antibiotic therapy in Lyme disease . Ann Intern Med . 1980;93:1-8.Crossref 15. Steere AC, Batsford WP, Weinberg M, et al. Lyme carditis: cardiac abnormalities of Lyme disease . Ann Intern Med . 1980;93:8-16.Crossref 16. Steere AC, Taylor E, Wilson ML, Levine JF, Speilman A. Longitudinal assessment of the clinical and epidemiological features of Lyme disease in a defined population . J Infect Dis . 1986;154:295-300.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Complete Heart Block as the Sole Presentation of Lyme Disease

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1989.00390080141032
Publisher site
See Article on Publisher Site

Abstract

Abstract • We report a case of Lyme myocarditis presenting solely as complete heart block in a previously healthy 32-year-old white man. Indium cardiac antimyosin scan showed diffuse uptake (2 +, on a scale of 0 to 4+) during the acute phase of the illness. The electrocardiogram and the indium cardiac antimyosin scan were normal 6 weeks after completion of tetracycline and prednisone treatment. Lyme carditis should be considered in the differential diagnosis of complete heart block of unclear origins, even in patients presenting without other signs or symptoms suggestive of Lyme disease. (Arch Intern Med. 1989:149:1897-1898) References 1. Williamson PH, Calaba JJ. Lyme disease: a review of the literature . Semin Arthritis Rheum . 1984;23:229-234.Crossref 2. Steere A. The clinical spectrum and treatment of Lyme disease . Yale J Biol Med . 1984;57:453-461. 3. Zipes DP. Specific arrhythmias: diagnosis and treatment . In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine . 3rd ed. Philadelphia, Pa: WB Saunders Co: 1988:658-718. 4. Vlay SC. Complete heart block due to Lyme disease . N Engl J Med . 1986;315:1418. 5. Roznick JW, Braunstein DB, Walsh RL, et al. Lyme carditis: electrophysiologic and histopathologic study . Am J Med . 1986;81:923-927.Crossref 6. Marcus LC, Steere AC, Duray PH, Anderson AE, Mahoney EB. Fatal pancarditis in a patient with coexistent Lyme disease and babesiosis . Ann Intern Med . 1985;103:374-376.Crossref 7. Ebright JR, Soin JS, Manoli RS. Thegallium scan: problems and misuse in examination of patients with suspected infection . Arch Intern Med . 1982;142:246-254.Crossref 8. Rienzo RJ, Merel DE, Prager D, Barron L, Post R. Gallium avid Lyme myocarditis . Clin Nucl Med . 1987;12:475-476.Crossref 9. Khaw BA, Gold HK, Tasida T, et al. Scintigraphic quantification of myocardial necrosis in patients after intravenous injection of myosin specific antibody . Circulation . 1986;74:501-508.Crossref 10. Khaw BA, Fallon JT, Benner GA, Haber E. Specificity of localization of myosin specific antibody fragment in experimental myocardial infarction: histologic histochemical, anteradiographic and scintigraphic studies . Circulation . 1979;60:1527-1534.Crossref 11. O'Connell JB, Hendin RE, Robinson JA, Subramanian R, Scanlon PJ, Gunnar RM. Gallium-67 imaging in patients with dilated cardiomyopathy and biopsy-proven myocarditis . Circulation . 1984;70:58-62.Crossref 12. Weber H. Die Lyme-Berrelioso . Hautarzt . 1986;37:583-586. 13. Olson LJ, Okafor EC, Clements EC. Cardiac involvement in Lyme disease: manifestations and management . Mayo Clin Proc . 1986;61:746-749.Crossref 14. Steere AC, Malawista SE, Newman JH, Spieler PN, Bartenhagen NH. Antibiotic therapy in Lyme disease . Ann Intern Med . 1980;93:1-8.Crossref 15. Steere AC, Batsford WP, Weinberg M, et al. Lyme carditis: cardiac abnormalities of Lyme disease . Ann Intern Med . 1980;93:8-16.Crossref 16. Steere AC, Taylor E, Wilson ML, Levine JF, Speilman A. Longitudinal assessment of the clinical and epidemiological features of Lyme disease in a defined population . J Infect Dis . 1986;154:295-300.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 1, 1989

References