Can Lyme Disease Trigger Sarcoidosis?
The relationship between Lyme disease and sarcoidosis has drawn increasing interest among researchers. Sarcoidosis is an inflammatory disorder characterized by granulomas—clusters of immune cells that can affect multiple organs, most commonly the lungs and lymph nodes.
According to the American Lung Association, an “infection or exposure to something in the environment can trigger the immune system to overreact,” resulting in sarcoidosis.¹
Some researchers have proposed that Borrelia burgdorferi, the bacterium responsible for Lyme disease, may be one of the infectious triggers capable of initiating this immune response.
Case report: Sarcoidosis associated with Lyme disease exposure
In a 2018 study, van Dee and colleagues describe the case of a young man whose sarcoidosis developed following exposure to ticks carrying Borrelia burgdorferi.²
The case report, “Systemic Sarcoidosis Associated with Exposure to Borrelia burgdorferi in a 21-Year-Old Man,” involved a forestry worker admitted to the emergency department with several concerning symptoms.
He presented with:
- Headaches
- A drooping left eyelid
- Swelling and redness of both legs
- Fatigue
- Weight loss
- Loss of appetite
- Chest discomfort
- Excessive thirst and nighttime urination
Biopsies of lymph node and skin tissue revealed non-caseating granulomas, leading to a diagnosis of systemic sarcoidosis.
The disease had affected multiple organs, including the patient’s lungs, kidneys, and skin.
Testing for Lyme disease
Because the patient worked as a forestry worker with significant tick exposure, clinicians considered the possibility of Lyme disease.
A spinal tap and additional testing confirmed Lyme disease infection.
The patient was treated with a combination of high-dose prednisolone and antibiotics, including:
- Two weeks of intravenous ceftriaxone
- Four weeks of oral doxycycline
“The patient recovered quickly within a few days of starting a high-dose prednisolone regimen and was discharged free of symptoms and in good health,” the authors reported.
Evidence linking Borrelia and sarcoidosis
Other researchers have also explored the possible role of Borrelia species in sarcoidosis.
A 2009 study reported finding “Borrelia-like” organisms in biopsy samples taken from patients with cutaneous sarcoidosis.³
“Usually single spirochetes, rarely pairs or small clusters of bacteria were observed between collagen bundles or at the periphery of granulomas,” the authors noted.
Why infections may trigger sarcoidosis
Sarcoidosis is believed to result from an exaggerated immune response in genetically susceptible individuals.
Possible triggers include:
- Infections
- Environmental exposures
- Immune system dysregulation
In some cases, infections such as Lyme disease may stimulate immune reactions that lead to granuloma formation.
Clinical implications
Identifying potential infectious triggers is important before beginning immunosuppressive treatment.
Van Dee and colleagues suggest that clinicians should maintain a high index of suspicion for infectious conditions such as neuroborreliosis when evaluating patients with newly diagnosed sarcoidosis.
Patients with tick exposure or compatible symptoms may benefit from evaluation for tick-borne infections before initiating immunosuppressive therapy.
Key Point
Research suggests that infections such as Lyme disease may trigger immune responses associated with sarcoidosis in some individuals.
Clinical Insight
When patients present with new-onset sarcoidosis and a history of tick exposure, clinicians should consider the possibility of underlying Lyme disease or other tick-borne infections before starting immunosuppressive therapy.
Related Articles
Lyme disease manifests as autoimmune disorder
References
- American Lung Association. https://www.lung.org
- van Dee L, Stehouwer M, van Bemmel T. Systemic Sarcoidosis Associated with Exposure to Borrelia burgdorferi in a 21-Year-Old Man. European Journal of Case Reports in Internal Medicine. 2018.
- Derler AM, Eisendle K, Baltaci M, Obermoser G, Zelger B. High prevalence of “Borrelia-like” organisms in skin biopsies of sarcoidosis patients from Western Austria. J Cutan Pathol. 2009.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I had Sarcoidosis in 1976-77 & Lyme around the same time. Got bit the summer of 76 .
Interesting article Thank you, Dr. Since this is an autoimmune disease article I would like to know if you have information on the significance of a very elevated (1280 titer) antinuclear antibodies test along with a very elevated C4a of 1680. From what I understand the antibodies are inside of the nucleus which is probably not I good. The neuromuscular doctor that ordered the ANA profile is far from lyme literate.
Dr. Cameron I would very much appreciate your insight. I was treated two weeks after my known tick bite that was on me approximately 53 hours Treated over phone consult at beginning of Covid for 3 weeks. I slipped through the cracks on follow up. Did not know that I should have been seen after completing Doxy, especially with new symptoms occurring on Day 11 and continuing for now 7 months. My initial presenting symptoms were always mild.
Then through learning about Lyme and coinfections and all that goes along with a bite , I Learned that the new symptoms that started on day 11 of Doxy is small fiber neuropathy . It’s not anything that I cannot deal with, but I have the concerns that the antibodies are within the nucleus of my cells with a high titer! And the added fact of the very elevated C4a I haven’t seen mention on your threads about this type of thing and whether my immune system is still capable of correction with the antibodies INSIDE of the cells. I would very much appreciate any insight you could give me regarding this, Dr!!
I find a C4a can show inflammation but not the cause of the inflammation. An ANA can be elevated from many causes. You many never find a cause for the ANA elevation. I have not heard that an ANA reflects antibodies in the nucleus. You will have to be evaluated or other causes. For example, you would need to see a neurologist to address your concerns with small fiber neuropathy.
Interesting article. I looked it up because I was bitten by a tick in 1992, resulting in positive Lyme titre & negative syphilis test (since they’re caused by the same spirochete) & back then, syphilis test was more accurate. I had 3 week course of Doxy but that’s it & I had no symptoms except for the ‘target’ sore behind my knee. Fast forward abt 12 years, when I was exposed in an apartment to probably several different types of mold! It was disgusting! I got out of that apartment, but shortly after, I tested positive for Sarcoidosis with ACE, ANCA, CRP and renal & lymph node biopsies AFTER having a biopsy; chemo for breast cancer. My sxs can be severe at times but because of CKD, my choices of Tx are very limited.
Nobody in my paternal or maternal family had breast cancer except my paternal great grandmother that died from it. From all of my researching, I am curious as to if the mold exposure was the culprit. However, I am unable to find much on that combo.
Any thoughts?
Thank you!
I have not found sufficient published information to address your Mold question. I am curious as to whether Lyme disease was adequately treated. For now, you will have to rely on a rheumatologist.
I’ve had Lyme symptoms since 2016 (negative tests & no rash); in October 2019, I was treated for an active infection (erythema migrants, but negative test). In early 2020 I was diagnosed with PLDTS, and sent on my way. In November of 2020, I started reliving sxs of active Lyme. Both Lyme and Covid tests negative. Since then, the cramps and muscle fatigue have continued as has my dry hacking cough. These briefly responded to antibiotics and prednisone, but returned once the Tx ended. Currently my lung function is at 49%. Lung X-rays are clear, and echocardiogram revealed to damage. Two other family members are currently being treated for sarcoidosis and I had erythema nodosa and lymph swelling throughout my teens and 20s. Could the lung issues be a resurgence of sarcoidosis triggered by the Lyme?
Great question. I don’t know the answer.
I had a left frozen shoulder in 2018, then bilateral facial palsy in sept and Dec 2019, followed by severe headaches for months which then resided, leaving me with dry/burning eyes, dry nose and mouth and reduced taste. Followed by muscle and joint pain all over and and now a right side frozen shoulder and another facial palsy last week. I had a Lyme disease test which was negative, and bloods for sjogrens, thyroid and sarcoidosis which we’re all negative.
A rheumatologist referred me for a Gallium scan which shows inflammation of all the joints, lacrimal gland and nasopharynx. Lymph nodes ok, chest X-ray clear and no skin lesions and no where to take a biopsy from. They seem to think I have sarcoidosis and are treating me as such with hydroxychloroquine.
However, I’m concerned that I’m still unwell, and various people I know keep telling me to have a different test done for Lyme disease saying that the blood tests don’t always pick it up. Is that correct?
Is there another test for lyme disease ?
Does it sound like I should be Re tested?
Bilateral Bell’s palsy followed by symptoms have been seen in Lyme disease. The tests for tick borne illness can be negative and still have the disease.
https://www.today.com/health/young-mom-had-heart-transplant-after-lyme-disease-t171329
Lyme test are unreliable, 50% chance of false negative or positive. Really don’t know why they use them at all. Clinical diagnosis by a LLMD is best for you and then treatment. Anyone else Really don’t know what they’re doing. Most important, stay positive ✨️
this is interesting i was bitten by something we were in the woods(i now presume a tick) and had a bulls eye rash on my arm. was on holiday at the time so waited till back in the uk and went to my doctors. was not tested for lyme disease and basically told it was nothing set home with some cream. fast forward two years and i was diagnosed with sarcoid after Lymphadenopathy of the mediastinal which presented on x-ray, extreme fatigue and swollen painful joints. i am starting to feel the two are connected
Lauren ,
Please see above comment from me regarding me also getting tick bites and subsequently getting a sarcoidosis result from biopsy some 18 months after the bites .
Again, it was swollen joints that led to the eventual Sarc diagnosis.
Regards
Paul
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301890/
Interesting article and comment from Lauren on 16/5/22 . Im also UK based and have just had a Synovectomy of the right middle finger and palm after 9 months of swelling in the tendon and the Histology report from biopsy says Sarcoidosis . I was bitten multiple times by deer ticks on one particular day some 6 months before the tendon swelling started and as there was no bullseye rash at the time of the bites I didn’t seek medical attention and forgot about the incident.
I only thought about Lyme as a cause of the swelling after I then started to experience other symptoms such as stabbing pains in ankles and toes as well as shoulder , wrist and elbow pain . Rheumatologist dismissed any suggestions of Lyme and a one stage basic NHS blood test proved negative for Lyme.
Just yesterday , 9th June 22 , the surgeon who did the synovectomy on my hand broke the news of the sarcoidosis diagnosis and he’s just submitted the histology report to the Rheumatologist who dismissed Lyme so it’ll be interesting to see what he now says when I show him this article, although I suspect he’ll still dismiss the Lyme link .
Hi Dr. Cameron. I was bitten by a tick and contracted HME (ehrlchiosis) but was never told i had lyme. On a recebt blot test.. I had a postive Igm p23ab anitbody but all others were negative. I have all the symptoms of lyme currently . Could i still have chronic lyme?
The tests are not as reliable as I would like. Furthermore, the treatment for Ehrlichia may have interfered with future tests. I advise my patients to use clinical judgement if they remain ill after looking at other illnesses.
Thank you for the reply! I plan on getting the ELISA test today to see if that indicates a positive result for lyme.
Also I had bad nasal sinus polyps and had surgery to remove them. I’m going to have a specialized eye exam.