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Journal article
Lyme disease presenting with facial palsy and myocarditis mimicking myocardial infarction
Journal of community hospital internal medicine perspectives, v 7(6), pp 363-365
01 Jan 2017
PMCID: PMC5738646
PMID: 29296249
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
A 45-year-old woman presented with a sudden episode of typical chest pain, radiating to her neck. The patient denied premature coronary artery disease in the family. Initial EKG showed normal sinus rhythm with a 1 mm ST-elevation involving lead II and lead aVF and a 1mm ST-depression in lead V1 with associated T-wave inversion. Initial Troponin I (normal <0.4 ng/mL) and CK-MB (normal <7.7 ng/mL) were elevated at 7.82 ng/mL and 55.2 ng/mL, respectively. Six hours later, Troponin I increased to 13.44 ng/mL and CK-MB to 75.7 ng/mL. The patient underwent cardiac catheterization which did not show any significant obstructive coronary artery disease. Two days later the patient developed right-sided facial palsy. Diagnosis of Lyme disease was confirmed by ELISA with positive IgM and IgG antibodies. Treatment with intravenous ceftriaxone and oral steroids was started. Eventually resolution of symptoms and, normalization of cardiac markers and EKG changes, were achieved. This is a rare case of Lyme myocarditis associated with markedly elevated Troponin I, normal left ventricle function, and an absence of conduction abnormalities. To the best of our knowledge, Lyme myocarditis mimicking acute coronary syndrome with such high levels of Troponin I and neurologic compromise has not been previously described. Lyme myocarditis may be a challenging diagnosis in endemic areas especially in patients with coronary artery disease risk factors, presenting with typical chest pain, EKG changes and positive cardiac biomarkers. Therefore, it should be considered a differential diagnosis in patients presenting with clinical symptoms suggestive of acute coronary syndrome.
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Details
- Title
- Lyme disease presenting with facial palsy and myocarditis mimicking myocardial infarction
- Creators
- Julieta Gilson - Easton HospitalKoroush Khalighi - Easton HospitalFarhad Elmi - Easton HospitalMahesh Krishnamurthy - Easton HospitalAmirsina Talebian - Department of Cardiology, Easton Cardiovascular Associates, Easton, PA, USA.Rubinder S. Toor - Milken Institute
- Publication Details
- Journal of community hospital internal medicine perspectives, v 7(6), pp 363-365
- Publisher
- Taylor & Francis
- Number of pages
- 3
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Medicine (Graduate)
- Web of Science ID
- WOS:000423898300006
- Other Identifier
- 991019169412004721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems