Lyme Disease and Breast Cancer: Overlapping Symptoms
Neurologic symptoms after breast cancer treatment can complicate diagnosis
Severe nerve pain, facial palsy, and foot drop may have multiple causes
Lyme disease may enter the differential diagnosis in some patients
Hello, and welcome to another Inside Lyme Podcast. I am your host, Dr. Daniel Cameron. In this episode, I discuss the case of a 61-year-old woman who developed Lyme disease after treatment for breast cancer.
The case was published in Diagnostics by Ørbæk and colleagues and highlights how Lyme disease may complicate evaluation in patients with prior cancer treatment.
Can Lyme Disease and Breast Cancer Symptoms Overlap?
Patients treated for breast cancer may later develop symptoms that are difficult to interpret, including nerve pain, weakness, facial palsy, sensory symptoms, and fatigue.
These symptoms may raise concerns about cancer recurrence, treatment side effects, or another medical condition. In some cases, Lyme disease may enter the differential diagnosis when exposure history and neurologic findings fit.
Cancer treatment itself may complicate diagnosis because chemotherapy, radiation, hormonal therapies, and infections can all contribute to neurologic symptoms, pain syndromes, and fatigue.
A 61-year-old woman was diagnosed with stage II breast cancer with lymph node metastasis. She underwent lumpectomy, chemotherapy, radiation therapy, and anti-estrogen treatment with letrozole.
One year later, she developed radicular leg and back pain that continued despite narcotic medication. Radicular pain follows the path of a nerve and may be severe.
Doctors initially suspected a blood clot or meningeal carcinomatosis and prescribed a blood thinner and high-dose steroids.
An MRI and PET scan found no evidence of cancer.
When Lyme Disease Mimics Cancer Complications
Over the next two weeks, her band-shaped pain and truncal dysesthesias worsened. Dysesthesia refers to a painful, itchy, burning, or restrictive sensation.
Doctors also observed foot drop on one side and right-sided facial palsy.
These findings raised concern because neurologic symptoms in a patient with breast cancer may suggest cancer-related complications, treatment effects, or another neurologic process.
In this case, Lyme disease became an important diagnostic consideration. Neurologic Lyme disease may involve radicular pain, facial palsy, sensory symptoms, and other neurologic findings. Additional discussion is available in neurologic Lyme disease.
Spinal Fluid Testing and Lyme Neuroborreliosis
A spinal tap was performed because of unexplained neurologic findings. Results showed pleocytosis and elevated protein.
Lyme disease testing by blood and spinal fluid was positive.
The woman was prescribed intravenous ceftriaxone for 14 days. She became pain free despite previously severe symptoms.
This case illustrates how Lyme neuroborreliosis may be difficult to distinguish from other causes of neurologic symptoms, especially in patients with a history of cancer or cancer treatment.
Lyme Disease and Cancer Treatment Questions
This case raises several important clinical questions for patients and clinicians.
- Have there been reports of cancer patients with Lyme disease?
- Can Lyme disease patients suffer from radicular leg and back pain?
- What is the significance of foot drop and Bell’s palsy?
- Can Lyme disease patients be in severe pain?
- How should clinicians distinguish Lyme disease symptoms from cancer-related complications?
- Was 14 days of antibiotics sufficient?
- What concerns arise when a patient requires chemotherapy, radiation, or hormonal treatment?
Can Lyme Disease Cause Cancer?
Some patients ask whether Lyme disease causes cancer. This case does not show that Lyme disease caused breast cancer or that breast cancer caused Lyme disease.
Instead, it illustrates that Lyme disease may appear in patients with a cancer history and may mimic cancer-related neurologic complications.
When new neurologic symptoms appear after cancer treatment, clinicians may need to consider recurrence, treatment-related complications, medication effects, infections, and tick-borne disease exposure.
Patients with persistent symptoms after treatment may also struggle with diagnostic uncertainty, which is discussed further in persistent Lyme disease symptoms.
Frequently Asked Questions
Can Lyme disease occur in a breast cancer patient?
Yes. Patients with breast cancer can also develop Lyme disease, particularly in endemic areas.
Can Lyme disease mimic cancer complications?
Yes. Neurologic Lyme disease may cause severe pain, facial palsy, sensory symptoms, foot drop, and spinal fluid abnormalities.
Can Lyme disease cause breast cancer?
This case does not show that Lyme disease causes breast cancer. It demonstrates diagnostic overlap.
Can cancer treatment make Lyme disease harder to diagnose?
Yes. Cancer treatments and Lyme disease may share overlapping symptoms, which may complicate evaluation.
Why was spinal fluid testing important?
Spinal fluid testing helped evaluate unexplained neurologic symptoms and supported the diagnosis.
Clinical Takeaway
Lyme disease and breast cancer may overlap clinically when neurologic symptoms appear after cancer treatment.
Severe radicular pain, facial palsy, foot drop, and spinal fluid abnormalities should prompt careful evaluation rather than automatic attribution to cancer recurrence or treatment effects.
This case does not show that Lyme disease causes cancer. It shows that Lyme disease may mimic cancer-related neurologic complications and should remain in the differential diagnosis when symptoms and exposure history fit.
Related Articles
Persistent Lyme disease symptoms
References
-
- Ørbæk M, Klausen C, Lebech AM, Mens H. Lyme Neuroborreliosis in a Patient with Breast Cancer: MRI and PET/CT Findings. Diagnostics (Basel). 2020;10(1):E36.
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 was Dx with Bacterial Meningitis in college in 1992. Dx with Lyme Disease in 2017 and Breast cancer in 2022. Was treated with Tamoxifen then Anastrozole, but had to discontinue due to extreme joint and musculoskeletal pain. Was switched to Examestane, but also had to discontinue to to extreme joint and musculoskeletal pain throughout entire body, made me feel like an 80 year old. Have since discontinue all cancer meds. My oncologist @ The University of Miami-Sylvester Cancer Center is considering putting me on a low dose Tamoxifen in April after a break of all cancer meds. Interested in your insights Dr. Cameron.