July 08, 2009
Palpitations and dizziness prompted a previously healthy 21-year-old cable lineman from southeastern Pennsylvania to seek medical attention. An ECG showed first-degree heart block. The young man was scheduled for outpatient cardiology consultation, but his symptoms worsened and he presented to an emergency department with chest pain and fever 2 days later. Further evaluation revealed that for the past 3 weeks he had myalgia; arthralgia; fatigue; and an expanding, erythematous, nonpruritic rash on his trunk and extremities. He did not recall any tick bites.