Burns Michael, Robben Paul, Venkataraman Ramesh
Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889-5611, USA.
Department of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD 20889-5611, USA.
Mil Med. 2023 Jul 22;188(7-8). doi: 10.1093/milmed/usab420. Epub 2021 Oct 6.
Lyme disease is a vector-borne infection that can affect multiple different organ systems. Lyme carditis represents one of these sequelae and is defined by acute onset of high-grade atrioventricular block in the presence of laboratory-confirmed infection. Current guidelines recommend patients with Lyme carditis be admitted for close cardiac monitoring and intravenous antibiotics therapy. Our case illustrates an active duty male who was initially diagnosed with Lyme disease after initially reporting symptoms including headache, fever, eye pain, and rash, with subsequent development of exercise intolerance 6 weeks later. An electrocardiogram (ECG) obtained at that time was misinterpreted as first-degree heart block, and he was initiated on oral doxycycline therapy and referred to cardiology. On follow-up to cardiology clinic, the prior ECG was reviewed and interpreted as complete heart block. A repeat ECG showed resolution of the heart block, and exercise stress testing showed chronotropic competence. This case illustrates the resolution of complete heart block in Lyme carditis with oral doxycycline, suggesting this antibiotic as a possible alternative treatment agent.
莱姆病是一种可通过媒介传播的感染性疾病，可影响多个不同的器官系统。莱姆病性心肌炎是其中一种后遗症，其定义为在实验室确诊感染的情况下，急性发生高度房室传导阻滞。当前指南建议，莱姆病性心肌炎患者应住院接受密切心脏监测及静脉抗生素治疗。我们的病例是一名现役男性，最初报告出现头痛、发热、眼痛和皮疹等症状后被诊断为莱姆病，6周后出现运动不耐受。当时进行的心电图（ECG）被误诊为一度心脏传导阻滞，他开始接受口服多西环素治疗并转诊至心脏病科。在心脏病科门诊随访时，复查了之前的心电图并解读为完全性心脏传导阻滞。再次心电图显示心脏传导阻滞已缓解，运动负荷试验显示心率反应正常。该病例说明了口服多西环素可使莱姆病性心肌炎的完全性心脏传导阻滞得到缓解，提示这种抗生素可能是一种替代治疗药物。
