Chest Pain in a Military Recruit
Chest Pain in a Military Recruit
Lyme borreliosis remains an important and common vector- borne illness in the United States, Europe, and Asia. In the majority of cases, it presents as a localized rash that seldom causes further complications with antibiotic treatment. If left undetected however, various neurologic, cardiovascular, and musculoskeletal manifestations may occur. Reported here is the case of a basic military trainee who first presented with cardiac manifestations of Lyme disease, highlighting this tick-borne illness as a rare, easily forgotten, and treatable cause of complete heart block.
Since its first description over twenty-five years ago, Lyme disease has become the most common vector-borne illness in the United States. The agent spirochete, Borrelia burgdoferi, is transmitted through the bite of the Ixodes tick, which is endemic in the northeastern, midwestern, and northwestern United States, as well as Europe and Asia. Lyme disease typically occurs in the summer months when the tick is in the nymph stage. It is often difficult to detect the tick attached to skin due to the small size of the nymphs. When attached for greater than 36 hours, Borrelia burgdorferi is transmitted through the tick's saliva to the patient. Early localized infection (stage I) consists of erythema migrans. Days to weeks later, early disseminated infection (stage II) follows with neurologic, cardiac, or musculoskeletal manifestations and subsequently late or persistent infection (stage III).
In up to 85% of cases, Lyme disease initially presents with erythema migrans, a slowly expansive rash with central clearing at the bite site. Onset is typically within 7 to 10 days after the bite, often presenting as a macule or papule with subsequent expansion over the course of days to weeks. Varying degrees of central clearing are observed, though vesicular or necrotic areas may appear in the center of the rash. Flu-like symptoms are also frequently reported. Most cases are successfully treated with antibiotics at this stage without further evidence of clinical progression. However, Lyme carditis occurs after weeks to months in approximately 5% of untreated cases and encompasses a variety of cardiac manifestations, with conduction abnormalities being the most common. Myocarditis is an exceedingly rare manifestation, occurring in less than 1% of cases. We report the case of a basic military trainee who first presented with cardiac manifestations of Lyme disease, highlighting this tick-borne illness as a rare, easily forgotten, and treatable cause of complete heart block.
Lyme borreliosis remains an important and common vector- borne illness in the United States, Europe, and Asia. In the majority of cases, it presents as a localized rash that seldom causes further complications with antibiotic treatment. If left undetected however, various neurologic, cardiovascular, and musculoskeletal manifestations may occur. Reported here is the case of a basic military trainee who first presented with cardiac manifestations of Lyme disease, highlighting this tick-borne illness as a rare, easily forgotten, and treatable cause of complete heart block.
Since its first description over twenty-five years ago, Lyme disease has become the most common vector-borne illness in the United States. The agent spirochete, Borrelia burgdoferi, is transmitted through the bite of the Ixodes tick, which is endemic in the northeastern, midwestern, and northwestern United States, as well as Europe and Asia. Lyme disease typically occurs in the summer months when the tick is in the nymph stage. It is often difficult to detect the tick attached to skin due to the small size of the nymphs. When attached for greater than 36 hours, Borrelia burgdorferi is transmitted through the tick's saliva to the patient. Early localized infection (stage I) consists of erythema migrans. Days to weeks later, early disseminated infection (stage II) follows with neurologic, cardiac, or musculoskeletal manifestations and subsequently late or persistent infection (stage III).
In up to 85% of cases, Lyme disease initially presents with erythema migrans, a slowly expansive rash with central clearing at the bite site. Onset is typically within 7 to 10 days after the bite, often presenting as a macule or papule with subsequent expansion over the course of days to weeks. Varying degrees of central clearing are observed, though vesicular or necrotic areas may appear in the center of the rash. Flu-like symptoms are also frequently reported. Most cases are successfully treated with antibiotics at this stage without further evidence of clinical progression. However, Lyme carditis occurs after weeks to months in approximately 5% of untreated cases and encompasses a variety of cardiac manifestations, with conduction abnormalities being the most common. Myocarditis is an exceedingly rare manifestation, occurring in less than 1% of cases. We report the case of a basic military trainee who first presented with cardiac manifestations of Lyme disease, highlighting this tick-borne illness as a rare, easily forgotten, and treatable cause of complete heart block.
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