Author/Authors :
Kerndt, Connor C. Department of Internal Medicine - Spectrum Health Butterworth Hospital, Grand Rapids, Michigan, USA , Bills, John A. Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA , Sharee, Zaid J. Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA , Balinski, Alexander M. Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA , Summers, Daniel F. Department of Internal Medicine - Spectrum Health Butterworth Hospital, Grand Rapids, Michigan, USA , Tan, Jose M. Department of Internal Medicine - Spectrum Health Butterworth Hospital, Grand Rapids, Michigan, USA
Abstract :
Lyme disease is the most common tick-borne illness in the United States due to Borrelia burgdorferi infection. This case
demonstrates a 20-year-old male patient presenting with complaints of annular skin rash, malaise, fever, and lightheadedness
after significant outdoor exposure. Physical exam revealed multiple large targetoid lesions on the back and extremities. The rash
had raised borders and centralized clearing consistent with erythema migrans chronicum. Electrocardiogram (ECG) revealed a
high-degree atrioventricular (AV) block. The patient was started on intravenous ceftriaxone due to clinical suspicion for Lyme
carditis. ELISA and Western blot tests were reactive for Lyme IgM and IgG, confirming the diagnosis. The AV block resolved by
hospital day four and the patient was discharged with outpatient follow-up. Early identification of disease allowed for effective
treatment with no adverse outcomes or sequelae.
