Key result
Doxycycline therapy resolved signs and symptoms in a patient with Lyme disease who initially presented with chest pain and ST elevations mimicking acute coronary syndrome.
Case Report (n=1)
Lyme carditis can mimic acute coronary syndrome with ST elevations and myocardial involvement, highlighting the need for broad differential diagnosis in atypical presentations.
Lyme borreliosis is the most common tick-borne disease in the United States. It is caused by spirochetes of the Borrelia burgdorferi species complex. Lyme disease has a myriad of incident symptoms, which can involve the skin as well as the musculoskeletal, neurologic, and cardiovascular systems. Cardiac manifestations usually involve the conduction system, but it may involve the endocardium, myocardium, or pericardium. We report a case where Lyme disease initially presented with chest pain and ST elevations in the inferolateral leads suggestive of an acute coronary syndrome. Patient had myocardial involvement on magnetic resonance imaging. Twenty-eight days later in follow-up, he had atrioventricular conduction delay. Enzyme-linked immunoassay and Western blot were positive for Lyme disease (IgM and IgG). Signs and symptoms resolved after therapy with doxycycline.
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Tamez et al. (2010) conducted a case report in Lyme disease presenting as acute coronary syndrome (n=1). Doxycycline was evaluated on Resolution of signs and symptoms. Doxycycline therapy resolved signs and symptoms in a patient with Lyme disease who initially presented with chest pain and ST elevations mimicking acute coronary syndrome.
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