Lyme carditis with pericarditis: A review of clinical cases

Table 1 Summary of documented cases of pericarditis, myopericarditis, and pericardial effusion in Lyme disease

No.	Ref.	Age, Sex	Pericardial involvement	ECG findings	Echo/imaging	Other symptoms/history	Laboratory confirmation	Time from TB/EM	Treatment	Complications	Outcome
1	Steere et al[4], 1980		Pericardial friction rub	ST-T changes (myopericarditis)		EM (presumed)	Clinical (EM)				Recovery
2	Steere et al[4], 1980		Small effusion	Diffuse ST↓ (anterolateral)	Echo: Small effusion; LVEF 52%	EM (presumed)	Clinical (EM)			Mild LV dysfunction	Recovery, LVEF normalized
3	Veyssier et al[17], 1987	59 (male)	Recurrent effusion (no tamponade)	ST↑ (concave) D3, aVF, V1-V6; later T↓	Echo: Small posterior effusion (relapse)	Rural area; no skin/neuro signs; later arthralgias	IFA: 1:1024; CSF 1:4 to negative post-treatment	No TB, no EM	Aspirin, penicillin 1 million U/day × 21 days		Recovery, arthralgias persisted
4	Veyssier et al[17], 1987	38 (male)	Myopericarditis (moderate effusion + LV hypokinesis)	Sinus tachycardia 110, incomplete RBBB, mild ST↓ (D3, aVF)	Echo: Moderate effusion to almost disappeared	Fever, headache, myalgias; later arthralgias, conjunctivitis, uveitis	IFA: 1:2048		Indomethacin, penicillin 1 million U/day × 20 days		Good general condition, serology still positive
5	Cary et al[18], 1990	31 (male)	Fibrinous pericarditis (at autopsy)	Complete AVB (narrow QRS)		Farmworker; no systemic illness or rash	ELISA: 41 U; IFA 1:512; direct IgM IF: Negative	No TB, no EM		Complete AVB, death	Death
6	Bergler-Klein et al[19], 1993	22 (male)	Acute myopericarditis, no effusion	Sinus tachycardia 120, ST↑ I, II, aVL, aVF, V3-V5; later T↓; no AVB	Echo: Normal LV/RV, no effusion; MRI: Epicardial enhancement; scintigraphy: Diffuse uptake	Arthralgias, flu-like illness 3 weeks prior; no EM, no remembered TB	ELISA IgG + (OD 0.875/0.890); silver stain of biopsy: Spirochetes	No TB, no EM	Nitrates, heparin, aspirin (no antibiotics)		Spontaneous resolution within weeks
7	Bruyn et al[20], 1994	59 (male)	Large effusion, tamponade (750 mL)	Atrial fib to ST↑ V2-V4 after cardioversion	Echo: Large effusion to small after PC	Chest pain, fever, dyspnea; arthralgias (3 years); recalled TB 10 years prior with EM	IFA: IgM 1:128, IgG 1:256; spirochetes in pericardial fluid and synovium (silver stain)	TB 10 years, EM at that time	PC (750 mL); IV ceftriaxone 2 g/day × 14 days	Tamponade, PC	Recovery within days
8	Guex-Crosier and Herbort[21], 1994	31 (male)	Acute pericarditis (2 episodes)			Recurrent uveitis, pars planitis (since 1982); first pericarditis 1988	IFA 1:128; WB strongly positive (10 bands)		First episode: Augmentin + aspirin; recurrence: Indomethacin; then ceftriaxone 2 g/day IV × 14 days + doxycycline 200 mg/day × 2 weeks		Relapse-free > 4 years
9	Horowitz and Belkin[22], 1995	23 (male)	Acute myopericarditis, no effusion	ST↑ inferior and precordial	Echo: Mild diffuse LV hypokinesis, no effusion	Fever, headache, stiff neck; TB 3 weeks before (not attached); EM next day after admission	On admission: WB indeterminate; at 4 weeks: WB + (IgG 41, 58; IgM 41, 39, 25, 37, 30)	TB 3 weeks, EM found day after admission	Azithromycin (no effect); ceftriaxone IV; then PO amoxicillin		Recovery by day 5
10	Gasser et al[23], 1998	54 (female)	Recurrent effusion, hemodynamic compromise (800 mL)		Extensive effusion, “swinging heart”	Dyspnea, joint pain, paresthesia; TB 1 years before with EM	Serology IgG (positive; also, in fluid)	1 year	Colchicine, steroids, multiple PC (failures); finally, ceftriaxone 2 g/day × 14 days + PC	Recurrent effusion, multiple PC	Recovery, no recurrence at 1 year
11	Briant et al[24], 1997	69 (male)	Pericarditis, no effusion (tamponade ruled out)	Diffuse ST↑ all leads; shortened PR	Echo: No effusion; pleural effusion (left)	Esophageal pain (referred), syncope, nausea; Lyme disease 1 week prior	Lyme disease clinical (method not stated)		IV nitroglycerin, heparin; ceftriaxone	Syncope, hypotension, bradycardia	Recovery
12	Ocon et al[25], 2018	61 (male)	Hemorrhagic pericarditis, large effusion, tamponade (1400 mL)		Large circumferential effusion, tamponade physiology	Tick bite, EM 8 week prior; fever, chest pressure, arthralgia; AOSD diagnosed	Initial equivocal, later neg; clinical disease of Lyme; AOSD by Yamaguchi criteria	Approximately 8 weeks	Pericardiotomy, drainage; IV ceftriaxone; methylprednisolone + anakinra to prednisone	Tamponade, pericardiotomy	Recovery, symptom-free at 3 months
13	Nedeljković et al[26], 2018	32 (male)	Acute pericarditis, circular effusion (22 mm)	Signs of pericarditis (no details)	Circular effusion; CT: Bilateral pleural effusion	SOB, chest pain (1 week), later fever (CRP 285)	IgM ELISA (positive), WB (positive)		Ibuprofen + colchicine to amoxicillin/clavulanate + azithromycin to piperacillin-tazobactam to ceftriaxone		Resolution, effusion gone after 5 days ceftriaxone
14	Ameer et al[27], 2024	18 (male)	Pericarditis, no effusion	ST↑ V2; PR↓ II; PR↑ aVR	Echo: EF > 70%, no effusion	Chest pain, dyspnea, palpitations; EM on back (5 inches × 3 inches)	Initial Lyme Ab (negative); clinical diagnosis (EM)	Rash 1 week before admission	Aspirin, ibuprofen, colchicine, IV doxycycline to IV ceftriaxone, then PO doxycycline 14 days	NSVT, diarrhea	Recovery, lost to FU
15	Agho 2025[28]	69 (female)	Acute pericarditis, moderate to large effusion, tamponade physiology (450 mL drained)		CT: Large effusion; echo: Moderate-large effusion, RA collapse (< 50% cycle)	Chest pain, SOB, low-grade fever; asthma, factor V Leiden; no EM or TB mentioned	Lyme Ab screen > 1.23; WB: IgM reactive to 2 of 3 proteins		PO doxycycline 3 weeks, ibuprofen, colchicine; PC (450 mL)	Tamponade physiology, PC	Recovery, symptom-free at 2 months

Data are presented as reported in each source. LV: Left ventricular; ECG: Electrocardiogram; aVF: Augmented vector foot; AVB: Atrioventricular block; Echo: Echocardiography; aVL: Augmented vector left arm; aVR: Augmented vector right; LVEF: Left ventricular ejection fraction; RV: Right ventricle; MRI: Magnetic resonance imaging; PC: Pericardiocentesis; CT: Computed tomography; EF: Ejection fraction; RA: Right atrium; EM: Erythema migrans; TB: Tick bite; AOSD: Adult-onset Still’s disease; SOB: Shortness of breath; CRP: C-reactive protein; IV: Intravenous; IF: Immunofluorescence; IFA: Indirect immunofluorescence; CSF: Cerebrospinal fluid; ELISA: Enzyme-linked immunosorbent assay; OD: Optical density; WB: Western blot; Ab: Antibody; PO: Oral; NSVT: Non-sustained ventricular tachycardia; FU: Follow up.