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Case Reports in Emergency Medicine
Volume 2013 (2013), Article ID 380734, 3 pages
http://dx.doi.org/10.1155/2013/380734
Case Report

Lyme Carditis in an Immunocompromised Patient

Department of Emergency Medicine, University of Florida, 1329 SW 16th Street, P.O. Box 1000186, Gainesville, FL 32610-0186, USA

Received 24 May 2013; Accepted 2 July 2013

Academic Editors: L. Bojić, H. David, A. K. Exadaktylos, and K. Imanaka

Copyright © 2013 Matthew F. Ryan and Cobin Thorn. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We present a case of a 68-year-old man with a history of liver transplant and of chronic immunosuppression therapy who presented to the emergency department (ED) for fevers and worsening fatigue for two days. On further investigation, the patient was found to have a new first-degree heart block on his electrocardiograph. Coupled with the history of a recent tick bite, the patient was diagnosed with vector-borne carditis. Although the patient’s titers for various vectors remained negative, due to a long history of immunosuppression, he was treated for Lyme disease and his heart block completely resolved with antibiotic treatment. We describe details of the case as well as discuss the impacts of immunosuppression on vector-borne disease. Immunosuppressed patients represent a special population and can present with chief complaints made even more complicated by their medical history, and this case illustrates the importance of being mindful of how immunosuppression can affect a patient’s presentation. As the efficacy of antirejection medications improved, the ED may see an increasing number of patients with solid organ transplants. A greater understanding of this special patient population is key to formulating optimal treatment plans.