SHM Converge Scientific Abstract ePoster Gallery-A Heralding Case of Lyme Disease in Kentucky

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This case describes a 38-year-old previously healthy woman in Kentucky who presented with acute left facial droop, dyspnea on exertion, rash, and preceding myalgias, fatigue, and subjective fevers. She was bradycardic with second-degree AV block type II, later progressing to complete heart block. Exam and history were notable for erythema migrans and Bell’s palsy, raising concern for early disseminated Lyme disease despite no travel to a traditionally endemic region. She did report frequent tick exposure in northern Kentucky.  <br /><br />Laboratory testing showed elevated inflammatory markers and BNP. The patient was started empirically on IV ceftriaxone, and two-tier Lyme serology returned positive. After four days of treatment, her bradycardia resolved and facial palsy improved. She was discharged with a PICC line to complete a 21-day antibiotic course and a Holter monitor for follow-up.  <br /><br />The discussion highlights that Lyme disease is expanding beyond classic endemic regions and may be increasingly relevant in Kentucky due to growing tick and Borrelia burgdorferi presence. Early disseminated Lyme disease can cause erythema migrans, cranial nerve palsy, and carditis, including complete heart block. In stable patients, Lyme carditis with heart block can often be treated with antibiotics alone, with expected recovery over weeks. The case emphasizes the importance for hospitalists to recognize evolving geographic patterns, appropriately order and interpret two-tier testing, and manage serious complications of Lyme disease.

Asset Subtitle

Hunter Bechtold

Meta Tag

Author List Daniel T. Weaver, Hunter Bechtold

Category Clinical Vignettes

Concept Early Disseminated Lyme Disease

Concept Erythema Migrans

Concept Lyme Disease

Concept Two-tier Serologic Testing

Concept Lyme Carditis

Distinguished Non-Finalist

Presenter Organization University of Kentucky

Presenting Author Hunter Bechtold

Track Adult

Keywords

Lyme disease

early disseminated Lyme

complete heart block

Bell's palsy

erythema migrans

Lyme carditis

Borrelia burgdorferi

tick exposure

Kentucky

IV ceftriaxone

Early Disseminated Lyme Disease

Erythema Migrans

Lyme Disease

Two-tier Serologic Testing

Lyme Carditis