Lyme arthritis, caused by the spirochete Borrelia burgdorferi, can be recurrent or prolonged, whereas Lyme carditis is mostly nonrecurring. A prominent difference between arthritis and carditis is the differential representation of phagocytes in these lesions: polymorphonuclear leukocytes (PMN) are more prevalent in the joint, and macrophages predominate in the heart lesion. We have previously ...

We present a case of a 68-year-old man with a history of liver transplant and of chronic immunosuppression therapy who presented to the emergency department (ED) for fevers and worsening fatigue for two days. On further investigation, the patient was found to have a new first-degree heart block on his electrocardiograph. Coupled with the history of a recent tick bite, the patient was diagnosed ...

A 20-year-old man presented to the emergency department with 2 weeks of migratory arthralgias and several macular blanching rashes. A photograph taken by the patient upon initial eruption of the rash was presented during evaluation (Fig. 1). The lesions were suspicious for erythema migrans (Fig. 2). Upon review of systems, the patient earlier reported a brief episode of palpitations. Electrocar...

Case Report A 47-year-old woman presented with subacute fever, erythema migrans-like rash, shortness of breath, and spells of dizziness that had progressed to “blackouts.” At admission, complete atrioventricular (AV) block was present (Figure 1A), and ceftriaxone 1g was given initially for suspected Lyme disease. Within 6 hours of antimicrobial treatment, she developed polymorphic ventricular t...