Tavora Fabio, Burke Allen, Li Ling, Franks Teri J, Virmani Renu
Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, DC, USA.
Cardiovasc Pathol. 2008 Mar-Apr;17(2):103-7. doi: 10.1016/j.carpath.2007.03.004. Epub 2007 May 11.
Cardiac involvement in Lyme disease is uncommon and typically manifests clinically by conduction disturbances. Postmortem identification of Borrelia burgdorferi has never been reported in a case of Lyme carditis.
We describe the case of a 37-year-old Caucasian man with a 1-month history of fevers, rash, and malaise who died unexpectedly on the day after he underwent medical evaluation. The only clinical cardiac abnormality found was that of second-degree atrioventricular block. At autopsy, a diffuse carditis, characterized by infiltrates of macrophages, lymphocytes, and eosinophils and primarily in an interstitial, endocardial, and perivascular distribution, was found. Serologic testing from blood drawn on the day before his death demonstrated IgG and IgM antibodies against B. burgdorferi, confirmed by Western blot. Postmortem polymerase chain reaction (PCR) performed in myocardial tissue amplified B. burgdorferi DNA encoding outer-surface protein A.
Lyme carditis should be considered in the differential diagnosis of interstitial myocarditis with mixed inflammatory infiltrates. This diagnosis can be confirmed by PCR testing.
莱姆病累及心脏的情况并不常见，临床上通常表现为传导障碍。莱姆病性心肌炎病例中，从未有过尸检时鉴定出伯氏疏螺旋体的报道。
我们描述了一名37岁白种男性的病例，该患者有1个月的发热、皮疹和不适病史，在接受医学评估后的第二天意外死亡。发现的唯一临床心脏异常是二度房室传导阻滞。尸检时发现弥漫性心肌炎，其特征为巨噬细胞、淋巴细胞和嗜酸性粒细胞浸润，主要分布于间质、心内膜和血管周围。在其死亡前一天采集的血液进行的血清学检测显示，针对伯氏疏螺旋体的IgG和IgM抗体呈阳性，经免疫印迹法确认。在心肌组织中进行的尸检后聚合酶链反应（PCR）扩增出了编码外表面蛋白A的伯氏疏螺旋体DNA。
在鉴别诊断伴有混合性炎性浸润的间质性心肌炎时，应考虑莱姆病性心肌炎。这一诊断可通过PCR检测得以证实。
