SYNCOPE: A RARE PRESENTATION OF LYME DISEASE

J Emerg Med. 2023 Jul;65(1):e23-e26. doi: 10.1016/j.jemermed.2023.04.002. Epub 2023 Apr 14.

Abstract

Background: Lyme disease is one of the most common vector-borne illnesses in the United States. It is caused by Borrelia burgdorferi infection transmitted via the Ixodes tick. Rarely, it can progress to early disseminated Lyme disease with cardiac or neurologic manifestations, or both.

Case report: A 41-year-old previously healthy man presented to the emergency department (ED) by ambulance after an episode of syncope. Electrocardiogram revealed right bundle branch block with borderline first-degree atrioventricular nodal block. During his admission he was noted to have night sweats and elevated procalcitonin. Infectious workup revealed positive Borrelia enzyme-linked immunosorbent assay. Further testing revealed positive Borrelia immunoglobulin M with negative immunoglobulin G, indicating a recent infection. Why should an emergency physician be aware of this? Lyme disease should be on the differential for patients presenting with vague, flu-like symptoms in the summer months in endemic areas. Treatment of early Lyme disease with doxycycline can prevent progression to secondary Lyme, which can present as a true cardiac or neurologic emergency.

Keywords: ECG; Lyme disease; carditis; right bundle branch block; syncope.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Atrioventricular Block*
  • Borrelia burgdorferi*
  • Doxycycline / therapeutic use
  • Humans
  • Lyme Disease* / complications
  • Lyme Disease* / diagnosis
  • Male
  • Syncope / complications

Substances

  • Doxycycline