Am J Med. 2018 Mar 29;:
Authors: Paim AC, Baddour LM, Pritt BS, Schuetz AN, Wilson JW
PURPOSE: We describe a case of Lyme endocarditis which, to our knowledge, is the first reported case confirmed by molecular diagnostics in the United States.
BACKGROUND: Valvular involvement as a manifestation of Lyme carditis is rare4. The first case describing a possible association between Lyme disease and cardiac valvular disease in the United States was published in 19935. Since that time, there have been 2 cases of Lyme endocarditis confirmed by Borrelia positive 16S rRNA polymerase chain reaction (PCR) and sequencing from valvular tissue8,10 and reported from Europe. We present the case of a 68-year-old male with progressive dyspnea had mitral valve perforation with severe mitral valve insufficiency and perforation seen on transesophageal echocardiogram. Subsequently resected valve tissue had sings of acute inflammation without organisms seen. Although blood and valve tissue cultures were negative, 16S rRNA PCR and sequencing demonstrated Borrelia burgdorferi.
CONCLUSION: Lyme endocarditis can be a challenging diagnosis to confirm, given the rarity of cases and the need for molecular tools of resected valve tissue. It should be included among diagnostic possibilities in patients with culture-negative endocarditis who have exposure to ticks in endemic and emerging areas of Lyme disease.
PMID: 29605416 [PubMed - as supplied by publisher]