Key result
Empirical initiation of doxycycline successfully treated a 61-year-old male presenting with tick-borne myopericarditis and septic shock associated with acute Lyme and anaplasma infections.
Why the study?
Myopericarditis is rarely reported in anaplasmosis and is difficult to diagnose, while potentially fatal Lyme carditis is also challenging to identify due to its rarity and nonspecific manifestations.
Case Report (n=1)
Tick-borne myopericarditis should be considered in endemic regions for patients presenting with carditis and shock, as prompt empirical doxycycline therapy can lead to rapid clinical recovery.
Suggests possible benefit of empirical doxycycline in endemic tick-borne myopericarditis with shock; single case leaves open need for prospective trials.
Myopericarditis has been reported only rarely in those with anaplasmosis and is typically difficult to diagnose. Lyme carditis can also be difficult to diagnose as it is relatively rare but potentially fatal and usually has nonspecific manifestations. We are presenting a 61-year-old male patient who presented in New Jersey, United States with unremitting fever, chills, and myalgia for two weeks along with nausea, vomiting, and diarrhea. Investigations were suggestive of perimyocarditis as was indicated by diffuse ST segment elevation on electrocardiography (EKG) with the presence of small pericardial effusion on echocardiography. A mild troponin leakage was also seen. This progressed to septic shock that required vasopressor therapy. Further history-taking revealed recent tick exposure and prompted empirical initiation of doxycycline. This proved to be successful with fever defervescence and clinical improvement. Serological tests confirmed both acute Lyme and anaplasma infections along with positive serology of Epstein Barr virus (EBV). This case highlights an uncommon presentation of carditis in acute Lyme and anaplasma infections with the associated false-positive serology of EBV.
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Arshad et al. (2023) conducted a case report in Tick-Borne Myopericarditis (n=1). Doxycycline was evaluated on Clinical improvement and fever defervescence. Empirical initiation of doxycycline successfully treated a 61-year-old male presenting with tick-borne myopericarditis and septic shock associated with acute Lyme and anaplasma infections.
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