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Description

Lyme carditis is an important and reversible manifestation of Borrelia burgdorferi infection that most commonly presents with atrioventricular (AV) conduction abnormalities. Early recognition is essential to prevent unnecessary pacemaker implantation; however, diagnosis may be delayed when dermatologic findings are atypical. We report a case of Lyme carditis presenting with complete heart block and an unusual rash morphology.

A previously healthy 52-year-old female presented with one week of fatigue, dyspnea on exertion, and lightheadedness. Electrocardiogram demonstrated hemodynamically stable complete heart block with a ventricular escape rhythm of 46 beats per minute. Physical examination revealed a flat, macular, purple rash approximately 5 cm in length on the right posterior flank, lacking the classic "bull's-eye" appearance of erythema migrans. Six weeks earlier, she experienced transient fever and headache and later provided images of an ulcerated rash at the same location. She did not recall a tick bite but reported outdoor gardening activity.

This case highlights the diagnostic challenge posed by non-classic erythema migrans presentations, including macular or ulcerated lesions that may be misinterpreted. Awareness of the broad dermatologic spectrum of Lyme disease is critical, as prompt empiric antibiotic therapy can lead to resolution of high-grade AV block and avoidance of unnecessary permanent pacemaker implantation.

Publication Date

5-8-2026

Disciplines

Cardiology

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2045

Lyme Carditis Presenting with Atypical Rash and Complete Heart Block

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