Lyme Myopericarditis With Effusive-Constrictive Physiology: Serial CMR Identifies a Reversible Inflammatory Phenotype.

Nazih Alhirtani, Grace Bigham, Carly Fabrizio, Craig A Laing, Rebecca Kumar, Syed Waqas Haider

Abstract readCase Reports

In one paragraph

Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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Authors and funding

6 authors.

Nazih AlhirtaniInternal Medicine Residency Program, MedStar Washington Hospital Center, Washington, DC, USA. Electronic address: Nazih.W.Alhirtani@MedStar.net.

Grace BighamMedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.

Carly FabrizioDepartment of Cardiology, Temple Heart and Vascular Institute, Philadelphia, Pennsylvania, USA; Temple Heart & Vascular Institute, Philadelphia, Pennsylvania, USA.

Craig A LaingDepartment of Cardiology, Bayhealth Cardiology, Milford, Delaware, USA.

Rebecca KumarDivision of Infectious Diseases and Travel Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.

Syed Waqas HaiderPericardial Disease Program, MedStar Heart and Vascular Institute, MedStar Georgetown University Hospital, Washington, DC, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLyme cardiac involvement typically presents with atrioventricular (AV) conduction disease. Pericardial involvement with effusive-constrictive physiology is uncommon. Distinguishing inflammatory from fixed constriction has important management implications. CASE SUMMARY: A 45-year-old man developed progressive pleuritic chest pain and dyspnea 4 months after a tick bite. An electrocardiogram showed diffuse ST-segment elevation with PR-segment depression without atrioventricular block, and he was treated for acute pericarditis. Persistent symptoms prompted echocardiography demonstrating moderate pericardial effusion and new left ventricular systolic dysfunction (left ventricular ejection fraction 35%-40%). Lyme serology showed IgG Western blot reactivity (10/10 bands), consistent with late disseminated Lyme disease. Cardiac magnetic resonance demonstrated diffuse pericardial thickening/enhancement with pericardial T2 edema, loculated effusion, right ventricular tethering, and ventricular interdependence. Right-heart catheterization confirmed effusive-constrictive physiology. He was treated medically, with recovery of left ventricular function without pericardiectomy. DISCUSSION: Serial cardiac magnetic resonance and invasive hemodynamics identified a reversible inflammatory phenotype supporting conservative therapy. TAKE-HOME MESSAGE: Multimodality imaging can identify a reversible inflammatory phenotype and guide therapy in effusive-constrictive pericarditis.

Indexed as

cardiac magnetic resonanceeffusive-constrictive pericarditislate gadolinium enhancementLyme carditispericardiocentesisventricular interdependence

Identifiers

PMID42400573

DOI10.1016/j.jaccas.2026.109021

PMCPMC13523459

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Textmetadata

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.