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Reversible high-grade atrioventricular block with septal myocardial edema in Lyme carditis

Reversibler hochgradiger atrioventrikulärer Block mit myokardialem Ödem des Septums bei Lyme-Karditis

Abstract

A 34-year-old road builder was admitted to the authors’ emergency department due to progressive dyspnoea that had been present for 6 days. The patient had a history of excessive smoking (60 cigarettes/day). The medical history was otherwise unremarkable. A transient rash had occurred during work 2 weeks previously. The patient could not remember a bite. The electrocardiogram showed 2:1 atrioventricular (AV) block with narrow QRS complexes. D‑dimer and C‑reactive protein were slightly elevated; all other laboratory findings were within normal range. Echocardiography revealed normal findings. ELISA and western blot analysis confirmed acute Lyme disease. Cardiac magnetic resonance imaging (MRI) disclosed myocardial edema in the interventricular septum. Antibiotic treatment with ceftriaxone was initiated for 2 weeks. The heart block improved to a first degree AV block (PR interval 274 ms) at day 5 of treatment. At discharge, the patient had a normal PR interval of 190 ms. Follow-up cardiac MRI revealed almost complete regression of the cardiac septal edema.

Zusammenfassung

Ein 34-jähriger Straßenbauer stellte sich wegen einer seit 6 Tagen bestehenden progredienten Dyspnoe in unserer Notaufnahme vor. Außer einem Nikotinkonsum von 60 Zigaretten pro Tag war die Anamnese unauffällig. Vierzehn Tage zuvor war ein flüchtiges generalisiertes Exanthem bei der Arbeit aufgetreten. Ein Insektenstich war nicht erinnerlich. Das Elektrokardiogramm zeigte einen 2:1-atrioventrikulären (AV) Block mit schmalen QRS-Komplexen. Laborchemisch bestand eine geringe Erhöhung von D‑Dimer und C‑reaktivem Protein. Alle übrigen Parameter waren im Normbereich. Die transthorakale Echokardiographie zeigte einen Normalbefund. Die mikrobiologische Untersuchung bestätigte eine akute Lyme-Borreliose im „enzyme-linked immunosorbent assay“ (ELISA) und Western Blot. Die kardiale Magnetresonanztomographie (MRT) zeigte ein myokardiales Ödem des interventrikulären Septums. Es erfolgte eine 14-tägige antibiotische Therapie mit Ceftriaxon. Hierunter bildete sich der AV-Block am Tag 5 in einen AV-Block ersten Grades mit einer PQ-Zeit von 274 ms zurück. Am Entlassungstag war die PQ-Zeit mit 190 ms im Normbereich. Die Kontroll-MRT zeigte eine nahezu komplette Rückbildung des myokardialen Ödems.

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Correspondence to D. Prochnau MD.

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D. Prochnau, J. Kühnemund, and J.P. Heyne declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case. Additional written informed consent was obtained from all individual participants or their legal representatives for whom identifying information is included in this article.

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Prochnau, D., Kühnemund, J. & Heyne, J.P. Reversible high-grade atrioventricular block with septal myocardial edema in Lyme carditis. Herzschr Elektrophys (2022). https://doi.org/10.1007/s00399-022-00879-3

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Keywords

  • Borrelia burgdorferi
  • Cardiac MRI
  • Antibiotic treatment
  • Lyme borreliosis
  • Heart block

Schlüsselwörter

  • Borrelia burgdorferi
  • Kardiale Magnetresonanztomographie
  • Antibiotische Therapie
  • Lyme-Borreliose
  • Herzblock