Zarghamravanbakhsh Paria, Saeidifard Farzane, Atteya Gourg, Murthi Swetha, Nash Ira, Skipitaris Nicholas T, Poretsky Leonid
Division of Endocrinology, Northwell Health, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York.
Department of Medicine, Lenox Hill Hospital, Northwell Health, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York.
AACE Clin Case Rep. 2022 Feb 15;8(4):150-153. doi: 10.1016/j.aace.2022.02.003. eCollection 2022 Jul-Aug.
BACKGROUND/OBJECTIVE: Lyme disease, the most common vector-borne infection in the United States, causes multisystem inflammation. We describe a patient who presented with symptoms of Lyme disease, carditis, and thyroiditis.
A 53-year-old woman developed fatigue and dyspnea on exertion 1 month after returning from a trip to Delaware. Her electrocardiogram (ECG) showed first-degree atrioventricular (AV) block with a P-R interval up to 392 milliseconds, in the setting of elevated free thyroxine and undetectable thyroid-stimulating hormone levels. Lyme serology was positive. She was hospitalized and started on ceftriaxone. During the second day of hospitalization, AV block worsened to second-degree Mobitz type II but converted back to first-degree AV block after a few hours. Her 24-hour I-123 thyroid uptake and scan revealed markedly diminished I-123 uptake of 1.2%. On day 4, the P-R interval improved, and she was discharged on doxycycline for 3 weeks. P-R interval on ECG and repeated thyroid function tests were normal after finishing antibiotic treatment.
In our patient, known exposure to the vector, a classic rash on the chest, improvement in the symptoms, and normalization of thyroid function tests after antibiotic therapy support Lyme infection as a cause of carditis and painless, autoimmune thyroiditis.
Our case highlights the importance of considering Lyme disease as a cause of painless, autoimmune thyroiditis, especially in patients with concurrent cardiovascular involvement.
背景/目的：莱姆病是美国最常见的媒介传播感染病，可引发多系统炎症。我们描述了一位出现莱姆病、心肌炎和甲状腺炎症状的患者。
一名53岁女性在从特拉华州旅行归来1个月后出现疲劳和劳力性呼吸困难。她的心电图显示一度房室传导阻滞，P-R间期长达392毫秒，同时游离甲状腺素升高，促甲状腺激素水平检测不到。莱姆病血清学检查呈阳性。她住院并开始使用头孢曲松治疗。住院第二天，房室传导阻滞恶化为二度莫氏Ⅱ型，但数小时后又恢复为一度房室传导阻滞。她的24小时I-123甲状腺摄取和扫描显示I-123摄取明显减少，仅为1.2%。第4天，P-R间期改善，她出院并接受3周的强力霉素治疗。抗生素治疗结束后，心电图上的P-R间期和重复的甲状腺功能检查均正常。
在我们的患者中，已知有媒介接触史、胸部出现典型皮疹、症状改善以及抗生素治疗后甲状腺功能检查正常，这些都支持莱姆感染是心肌炎和无痛性自身免疫性甲状腺炎的病因。
我们的病例强调了将莱姆病视为无痛性自身免疫性甲状腺炎病因的重要性，尤其是在并发心血管受累的患者中。
