Case Presentation

A 31 year-old Caucasian male with no significant past medicalhistory presents with increasing dizziness, chest pain, andshortness of breath of one day duration. On returning from acamping trip to Northern Pennsylvania three weeks prior toadmission, he noted high fevers, “joint pains all over,” and a pinkblotchy rash all over his chest and back. He did not recall anyinsect, tick or animal bites. His primary physician, who clinicallysuspected Lyme disease, ordered Lyme serologies and offered aprescription for doxycycline which the patient declined. Twoweeks later, the patient presented to the emergency departmentafter the onset of chest pain that he described as sharp, radiatingto both arms, occurring with exertion and relieved by rest. Thechest pain was associated with worsening shortness of breathand dizziness.