Autonomic Dysfunction After Lyme Disease and COVID-19

Autonomic dysfunction, also called dysautonomia, can occur after infections including Lyme disease and COVID-19. Patients may develop symptoms such as dizziness, brain fog, fatigue, and neuropathic pain when the autonomic nervous system is disrupted. This case highlights the complexity of diagnosing autonomic disorders in patients with a history of both infections.

I will be discussing autonomic dysfunction in a 64-year-old woman with a history of Lyme disease and COVID-19. She was initially diagnosed and treated for Lyme disease at the age of 60.

Clinical Case

The patient was later diagnosed with two autonomic disorders.

Her distal burning pain without weakness was diagnosed as small fiber neuropathy (SFN), a condition affecting the small sensory nerve fibers responsible for pain and temperature sensation.

Her dizziness, brain fog, and fatigue were diagnosed as orthostatic cerebral hypoperfusion syndrome (OCHOS). This condition occurs when blood flow to the brain drops while standing, leading to dizziness, cognitive slowing, and fatigue.

Autonomic Symptoms After Infection

Autonomic dysfunction affects the body’s automatic functions including heart rate, blood pressure regulation, digestion, and temperature control. Symptoms may include:

• Dizziness or lightheadedness
• Brain fog and difficulty concentrating
• Fatigue
• Burning neuropathic pain
• Exercise intolerance

These symptoms have been described in patients with Lyme disease–associated autonomic dysfunction as well as in individuals recovering from COVID-19.

Several mechanisms may contribute to autonomic dysfunction following infection, including immune activation, inflammation affecting small nerve fibers, and disruption of blood pressure regulation.

COVID-19 Infection at Age 64

At the age of 64, the patient developed COVID-19 pneumonia. She was treated with intravenous immunoglobulin (IVIG). Following recovery from the acute infection, she continued to experience headaches and fatigue.

The authors concluded that COVID-19 triggered an autoimmune response contributing to the patient’s autonomic dysfunction.

Could Lyme Disease Have Played a Role?

In this case, the patient had a history of Lyme disease prior to developing COVID-19. I would have questioned whether the autonomic dysfunction might have been related to her earlier Lyme disease rather than COVID-19 alone.

Autonomic disorders such as small fiber neuropathy and orthostatic intolerance have been described in patients with persistent symptoms after Lyme disease.

Diagnostic Challenges

Distinguishing between post-infectious autonomic dysfunction caused by Lyme disease and COVID-19 can be difficult. Both infections have been associated with dysautonomia, small fiber neuropathy, and orthostatic intolerance.

In some patients, symptoms may reflect overlapping mechanisms triggered by more than one infection.

Clinical Perspective

Infections can sometimes trigger persistent neurologic or autonomic symptoms. When patients develop dysautonomia after infections such as Lyme disease or COVID-19, clinicians should consider multiple potential causes rather than attributing symptoms to a single trigger.

Patients with persistent dizziness, brain fog, or fatigue following infections should be evaluated for autonomic dysfunction.

Fortunately, this 64-year-old woman with a history of headaches, hypothyroidism, and autonomic dysfunction associated with post-treatment Lyme disease syndrome (PTLDS) ultimately recovered from COVID-19.

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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