Abstract
Background
Valvular involvement as a manifestation of Lyme carditis is rare. The first case describing
a possible association between Lyme disease and cardiac valvular disease in the United
States was published in 1993. Since that time there have been 2 cases of Lyme endocarditis
confirmed by Borrelia-positive 16S ribosomal RNA polymerase chain reaction and sequencing from valvular
tissue and reported from Europe. Here we describe a case of Lyme endocarditis that,
to our knowledge, is the first reported case confirmed by molecular diagnostics in
the United States.
Methods
We present the case of a 68-year-old man with progressive dyspnea who had mitral valve
perforation with severe mitral valve insufficiency seen on transesophageal echocardiogram.
Results
Subsequently resected valve tissue had signs of acute inflammation without organisms
seen. Although blood and valve tissue cultures were negative, 16S ribosomal RNA polymerase
chain reaction 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.
Keywords
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Article info
Publication history
Published online: March 29, 2018
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the related data and participated in the process of writing the manuscript.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
