Professor of Surgery and Pediatrics Lexington, Kentucky, United States
Disclosure(s):
Joseph Zwischenberger, MD: No relevant disclosure to display
Background: In ~10% of untreated cases, Lyme disease causes cardiac dysfunction. Utilizing modified CPB with a heating element, oxygenator, dialyzer, and filter, patient’s blood was heated to 42℃ for 2 hrs. to achieve whole-body hyperthermia (HEATT®). Borrelia burgdorferi, Lyme causative agent, at 41.6℃ for 2 hours, 100% of the bacteria die.
Methods: A 60 yo female physician presented with a long-standing history of chronic fatigue, brain fog, joint and muscle pains. Over several years of worsening symptoms, she had chronic Borrelia infection (culture proven), positive IgG and IgM, as well as positive western blot. Treatment with antibiotics and traditional therapies failed. A mild systemic hyperthermia treatment in Germany achieved temporary (weeks) improvement. A radiologist, worsening symptoms led to a severe reduction in working hours and inability to take call. Following a full evaluation, informed consent was obtained, and she was brought to the OR, sedated, and intubated. HEATT® uses Femoral-Jugular cannulas placed by image guidance in a veno-venous closed circuit (all individual components FDA approved). Upon general anesthesia and systemic anticoagulation, interventional radiology placed an image-guided triple-lumen central line and arterial line for monitoring. They inserted an IVC venous cannula at L2 for drainage and SVC venous cannula at SVC/RA junction for infusion of heated blood. Flow increased to ~1L/min to slowly (~1 hr.) increase core temperature to 42℃ for 120 minutes, confirmed by rectal, bladder, esophageal, and tympanic temperature probes, cooled (~1 hr.) to 38℃, and then extubated and sent to ICU for recovery.
Outcome: HEATT® achieved target treatment of 42℃ core temperature for 120 minutes with no peri-treatment complications. She was discharged home on POD 2, supplemented by a two-week course of doxycycline. During follow-up to 6 months, the patient reported complete resolution of brain fog, and progressive improvement in joint, muscle pain, and fatigue. This was accompanied by negative serologic testing for Borrelia as well as negative IgM and IgG antibodies. She returned to full activity, works full time, and now takes call.
Conclusion: We report the first case of unresponsive chronic Lyme disease treated with HEATT®. Severe chronic symptoms were resolved at 6-month follow-up, and Borrelia titers fell to zero. We seek patients to develop a larger series, followed by clinical trials, to define the benefit of this innovative new treatment.
