A 12-year-old girl returns from a camping trip in a Lyme-endemic area. She reports an expanding erythematous rash on her thigh noted 2 weeks ago and now presents with presyncope. ECG shows complete atrioventricular dissociation with a ventricular escape rhythm at 40 bpm. Lyme serology is positive. Which of the following is the most appropriate management?
- A Permanent pacemaker implantation
- B Oral amoxicillin
- C Intravenous ceftriaxone ✓
- D Intravenous isoproterenol
Correct answer: C. Intravenous ceftriaxone
Explanation
Lyme carditis causing high-grade or complete AV block is treated with intravenous ceftriaxone. The block is usually reversible with antibiotic therapy, and permanent pacing is rarely needed. Oral amoxicillin is used for early localized or early disseminated disease without high-grade block. Isoproterenol is a temporizing measure and not the definitive treatment.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.