Overview
Myocarditis caused by Borrelia (Lyme disease) involves inflammation of the myocardium due to Borrelia burgdorferi infection, potentially leading to cardiac dysfunction and complications. 1 does not directly address Borrelia-induced myocarditis but provides context on endomyocardial fibrosis, which can overlap in clinical presentation.Diagnosis
Clinical Presentation: Often includes nonspecific symptoms like fever, fatigue, and chest pain; may present with cardiac masses or thrombi in severe cases 1.
Laboratory Tests: Elevated inflammatory markers, eosinophilia (in specific contexts like Löeffler endomyocarditis, though not Borrelia-specific) 1.
Imaging: Echocardiography may reveal mural thrombi, valvular abnormalities, or ventricular dysfunction 1.
Cardiac Biomarkers: Elevated troponin levels indicative of myocardial injury 1.
Serology: Lyme disease serology (ELISA followed by Western blot) to confirm Borrelia infection 1.
Histopathology: Biopsy showing characteristic inflammatory infiltrates in myocardium (when feasible) 1.Management
Antibiotics: First-line treatment with doxycycline, amoxicillin, or ceftriaxone, depending on stage and severity 1.
Corticosteroids: Considered in severe cases with significant inflammation or heart failure symptoms, dose typically prednisolone 1-2 mg/kg/day 1.
Supportive Care: Management of heart failure symptoms, anticoagulation if thrombosis is present 1.
Surgical Intervention: Indicated in advanced stages with significant structural damage or complications like persistent thrombi 1.Special Populations
Pediatrics: Specific considerations for younger patients may include more aggressive monitoring and early intervention due to potential for rapid progression 1.
Comorbidities: Presence of comorbidities like hypereosinophilia may influence severity and require tailored corticosteroid therapy 1.Key Recommendations
Confirm Borrelia infection with serologic testing (ELISA followed by Western blot) before initiating treatment (Evidence: Moderate) 1.
Initiate antibiotic therapy with doxycycline, amoxicillin, or ceftriaxone based on clinical presentation and severity (Evidence: Moderate) 1.
Consider corticosteroid therapy (prednisolone 1-2 mg/kg/day) in severe cases with significant inflammation or heart failure symptoms (Evidence: Weak) 1.References
1 De Cock C, Lemaitre J, Deuvaert FE. Löeffler endomyocarditis: a clinical presentation as right ventricular tumor. The Journal of heart valve disease 1998. link