SHM Converge Scientific Abstract ePoster Gallery-Blame the Bachelor Party; A Shocking Case of Lyme

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This case describes a 22-year-old previously healthy man who presented with one week of fever, headache, chills, myalgias, arthralgias, and a rash after recent outdoor exposures in Michigan and Iowa. His exam showed generalized erythematous lesions consistent with erythema migrans. Initial labs revealed significant inflammation, mild transaminitis, leukocytosis with neutrophilia, and elevated troponin. EKG showed sinus tachycardia with prolonged PR interval and nonspecific T-wave inversions; echocardiogram was unremarkable. Although the initial Lyme antibody test was negative, outpatient testing later returned positive.<br /><br />He was started on doxycycline for presumed Lyme disease but rapidly worsened and developed shock requiring vasopressor support. Because of concern for severe infection or drug reaction, antibiotics were broadened to Unasyn and vancomycin, and anaphylaxis was considered but ruled out with a normal tryptase. He was transferred to the ICU, then improved and was ultimately de-escalated back to doxycycline monotherapy and discharged to complete a 21-day course.<br /><br />The discussion highlights possible causes of shock in Lyme disease, including coinfection with other tick-borne pathogens such as Anaplasma, Babesia, or Ehrlichiosis, or a Jarisch-Herxheimer reaction after treatment initiation. The source of infection was unclear, but the case underscores that Lyme disease is endemic in Michigan and can occur after high-risk outdoor exposure even in lower-endemic areas like Iowa. The authors emphasize that careful clinical pattern recognition and prompt treatment led to the correct diagnosis and recovery.

Asset Subtitle

Abigale Oltman

Meta Tag

Author List Abigale Oltman, Jeremy J. Gentile, Kyle Rau, Theresa H. Nguyen

Category Clinical Vignettes

Concept Lyme Disease

Concept Erythema Migrans

Concept Serology

Concept Jarisch-Herxheimer Reaction

Concept Tick Exposure

Distinguished Non-Finalist

Presenter Organization Corewell Health/ Michigan State

Presenting Author Abigale Oltman

Track Adult

Keywords

Lyme disease

erythema migrans

tick-borne infection

shock

Jarisch-Herxheimer reaction

doxycycline

Michigan

Iowa

carditis

Anaplasma coinfection

Lyme Disease

Erythema Migrans

Serology

Jarisch-Herxheimer Reaction

Tick Exposure