Case Report

Chest Pain in a Military Recruit

Authors: Amy S. Beck DO, Jason F. Okulicz MD, Mark S. Rasnake MD

Abstract

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.


Key Points


* Lyme disease, a common cause of tick-borne illness in many areas of the globe, usually presents with the classic erythema migrans rash.


* Lyme carditis is a rare initial presentation of Lyme disease.


* High levels of suspicion for Lyme disease are needed when evaluating patients with cardiac abnormalities and suggestive histories.


* Serologic tests are used as confirmation.


* Treatment may prevent the need for permanent cardiac pacing and curtail neurologic manifestations of Lyme disease.

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