title: [The cardiac and neurological manifestations of Lyme borreliosis in congenital first-degree AV block].
abstract: METHODS
  A 19-year-old youth was hospitalised because of sudden onset of incomplete lid closure and drooping mouth on the left. He regularly walked through fields and woods; three weeks before 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 heart murmur and 1 degree AV block (P-R interval 0.25s) had been found. Physical examination showed peripheral facial paresis and a 2/6 systolic murmur over the aortic area.
  
  
  METHODS
  As Borreliosis (Lyme disease) was suspected, relevant laboratory tests were performed. These revealed specific IgM antibodies against Borrelia burgdorferi. Polymerase chain reaction demonstrated B. burgdorferi-specific DNA in cerebrospinal fluid and urine. The ECG showed 1 degree AV block (P-R interval 0.28s).
  
  
  METHODS
  Ceftriaxone was administered at once (4 g, followed by 2 g daily intravenously for 14 days). The P-R interval increased to maximally 0.31 s and transient incomplete right bundle 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 days of the start of treatment, while the P-R interval had returned to its initial value of 0.25 s 3 months later.
  
  
  CONCLUSIONS
  The case makes clear that an ECG should be recorded in borreliosis even in the absence of cardiac symptoms. Hospitalisation with long-term monitoring becomes necessary if it is abnormal.
authors.affiliation: Abteilung für Kardiologie, Medizinische Klinik sowie Hygiene-Institut, Universität Göttingen.
authors.forename: M
authors.initials: M
authors.lastname: Stille-Siegener
authors.forename: H
authors.initials: H
authors.lastname: Eiffert
authors.forename: S
authors.initials: S
authors.lastname: Vonhof
mesh_terms: D000328:Adult; D002443:Ceftriaxone / Q000008:administration & dosage; D002511:Cephalosporins / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004562:Electrocardiography; D005158:Facial Paralysis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006327:Heart Block / Q000150:complications* / Q000151:congenital* / Q000175:diagnosis / Q000628:therapy; D006337:Heart Murmurs / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008193:Lyme Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D010138:Pacemaker, Artificial; D012074:Remission Induction
chemical_list: D002511:Cephalosporins; D002443:Ceftriaxone
vernacular_title: Kardiale und neurologische Manifestationen der Lyme-Borreliose bei angeborenem AV-Block I. Grades.