engleski

Diagnostic challenges in treating patient with cardiogenic shock caused by Lyme disease

Introduction: Lyme disease is a multisystem disease caused by infection with Borelia burgdoferi and spread by a tick bite. Even though it most commonly affects the skin, joints and nervous system, it can rarely cause Lyme carditis.1 In Europe, cardiac involvement as a complica-tion of Lyme disease occurs in up to 4%, with 3-fold higher male predominance. The most common clinical feature of Lyme carditis is atrioventricular (AV) conduction block of varying severity but may also include decreased car-diac contractility due to myopericarditis. These cardiac features typically occur one to two months after the onset of infection. We present a case report of a patient with car-diogenic shock and later confirmed Lyme disease. Case report: 71-year-old patient, with two-month long history of progressive exertional dyspnea, was hospital-ized in coronary intensive care unit due to cardiogenic shock with severely impaired left ventricular function (EF 15% ; in 2016 EF was 56%) and developed signs of type 1 cardiorenal syndrome. The patient had no chest pain, no electrocardiographic signs of ischemia nor elevation of cardiac biomarkers. The patient initially required inotro-pic support that with other standard treatment for acute heart failure gradually led to clinical and echocardio-graphic improvement (EF 31%). The patient then under-went coronary angiography that showed diseased left an-terior descending coronary artery that was treated with two stents. Since acute myocardial infarction was not the cause of acute heart failure, other possible causes were in-vestigated, primarily myocarditis. More detailed clinical history revealed tick bite about two months prior to hos-pital admission, which rose suspicion of Lyme carditis, even though the patient had no registered AV conduction disturbances. An enzyme-linked immunosorbent as-say and Western blot both came seropositive for Borelia burgdoferi antibodies, confirming the diagnosis. Conclusion: Lyme carditis is a rare manifestation of boreliosis with possible lethal complications. Therefore, detailed clinical history and physical examination are crucial for making correct diagnosis and giving the right treatment.

Lyme disease, cardiogenic shock, myocarditis

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