Clinical Case ReportLyme disease: a case report of a 17-year-old male with fatal Lyme carditis
Introduction
Lyme disease is a tick-borne illness caused by the spirochete Borrelia burgdorferi. It is the most common vector-borne illness in the United States, with disease prevalence highest in the northeastern, mid-Atlantic, and north–central states [1], [2]. Early Lyme disease is typically characterized by a skin rash (erythema chronicum migrans), fever, fatigue, arthralgias, and myalgias [3]. If untreated, the infection can disseminate and can cause various manifestations depending on the potential sites of secondary involvement, including the nervous, cardiovascular, and musculoskeletal systems [4]. Of these, Lyme carditis is a relatively rare sequel and occurs in only 4%–10% of untreated patients [5]. Most commonly, adult patients with cardiac involvement present with a variable degree of self-limited atrioventricular conduction disturbance [5], [6], [7]. Lyme carditis in children is even less common but can also present with a spectrum of clinical derangements ranging from asymptomatic first-degree heart block to fulminant myocarditis [6]. Nevertheless, Lyme carditis is a self-limited condition, and full recovery is typically expected with timely supportive care and antibiotic therapy [6]. In the literature, few cases of fatal Lyme carditis have been reported in adults [8], [9]. In this paper, we report a case of fatal Lyme carditis in a previously healthy 17-year-old male.
Section snippets
Case report
In the summer, a 17-year-old previously healthy male was suffering from a 3-week history of a viral syndrome manifested by sore throat, cough, and occasional fever. The patient initially visited his pediatrician for nonspecific symptoms of upper respiratory tract infection, fever, malaise, and body aches. At that time of the visit, rapid group A streptococcus test, throat cultures, and serology tests for Lyme disease and anaplasmosis were all negative. A couple of days later, the patient
Discussion
Lyme disease is the most common tick-borne infectious disease in North America and in countries with temperate climates in Eurasia [10]. The CDC report that the incidence of Lyme disease increased 101% between 1992 and 2006 [11]. Approximately 30,000 cases of Lyme disease were reported in the United States in 2013 [8], [12]. Classically, the clinical manifestations of Lyme disease are divided into three stages: early localized, early disseminated, and late infection [13]. The early localized
Acknowledgments
The authors gratefully acknowledge the assistance of Drs. S. Wong, K. St. George, K. Musser, S. Zaki, and R. Rockwell, P. Kurpiel, C. Hertzog, L. Squires, K. Reiber and A. Rotans for laboratory testing and investigation of this case.
We remember Joseph as a kind, gentle, and caring person. Based on his interest in science and his compassionate nature, we believe he would approve of this manuscript to understand the disease that took him away from us.
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