CARDIAC AND NEUROLOGICAL MANIFESTATIONS O F BORRELIOSIS (LYME-DISEASE) IN A PATIENT WITH 1-DEGREES AV BLOCK

History and clinical findings: A 19-year-old youth was hospitalised be cause of sudden onset of incomplete lid closure and drooping mouth on the left. He regularly walked through fields and woods; three weeks be fore admission he had noted swelling and reddening on his neck, which he thought was due to an insect bite. When 9 years old a functional he art murmur and 1 degrees AV block (P-R interval 0,25 s) had been found , Physical examination showed peripheral facial paresis and a 2/6 syst olic murmur over the aortic area. Investigations: As Borreliosis (Lyme disease) was suspected, relevant laboratory tests were performed. The se revealed specific IgM antibodies against Borrelia burgdorferi. Poly merase chain reaction demonstrated B. burgdorferi-specific DNA in cere brospinal fluid and urine. The ECC showed 1 degrees AV block (P-R inte rval 0.28 s). Treatment and course: Ceftriaxone was administered at on ce (4 g, followed by 2 g daily intravenously for 14 days). The P-R int erval increased to maximally 0.31 s and transient incomplete right bun dle branch block developed on the second day. Long-term ECG monitoring also revealed ventricular arrhythmias (Lown IVb), but they gradually disappeared. The neurological signs regressed completely within five d ays of the start of treatment, while the P-R interval had returned to its initial value of 0.25 s 3 months later. Conclusion: The case makes clear that an ECG should be recorded in borreliosis even in the absen ce of cardiac symptoms. Hospitalisation with long-term monitoring beco mes necessary if it is abnormal.