ro13-9904 and Syncope

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Haiti; Hand Injuries; Humans; Poverty Areas; Sepsis; Syncope; Vomiting; Young Adult

Topics: Atrioventricular Block; Borrelia burgdorferi; Ceftriaxone; Electrocardiography; Emergency Service, Hospital; Humans; Lyme Disease; Male; Pacemaker, Artificial; Syncope; Treatment Outcome; Young Adult

The incidence of Lyme disease in the USA is 8 per 100 000 cases and 95% of those occur in the Northeastern region. Cardiac involvement occurs in only 1% of untreated patients. We describe the case of a 46-year-old man who presented with chest pressure, dyspnoea, palpitations and syncope. He presented initially with atrial fibrillation with rapid ventricular response, a rare manifestation of Lyme carditis. In another hospital presentation, he had varying degrees of atrioventricular block including Mobitz I second-degree heart block. After appropriate antibiotic treatment, he made a full recovery and his ECG normalised. The authors aim to urge physicians treating patients in endemic areas to consider Lyme carditis in the workup for patients with atrial fibrillation and unexplained heart block, as the associated atrioventricular nodal complications may be fatal.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Atrial Fibrillation; Atrioventricular Block; Blotting, Western; Ceftriaxone; Electrocardiography; Humans; Lyme Disease; Male; Middle Aged; Myocarditis; Rare Diseases; Syncope; Treatment Outcome

Topics: Anti-Bacterial Agents; Ceftriaxone; Electrocardiography; Heart Block; Humans; Lyme Disease; Male; Myocarditis; Syncope; Treatment Outcome; Young Adult

A 20-year-old Caucasian male patient presented after a single episode of syncope. His heart rate was 40 beats per minute. ECG showed new onset complete heart block. A temporary pacer was placed. He had a macular rash on the body from past 2 weeks and was diagnosed with contact dermatitis. Erythema migrans was considered as differential for rash. Lyme titre was ordered and found to be positive. After antibiotic therapy and observation on telemetry, his heart block resolved. He was subsequently discharged and a follow-up ECG revealed persistent normal sinus rhythm.

Topics: Anti-Bacterial Agents; Bradycardia; Ceftriaxone; Electrocardiography; Erythema Chronicum Migrans; Heart Block; Humans; Lyme Disease; Male; Myocarditis; Pacemaker, Artificial; Syncope; Treatment Outcome; Young Adult