Can Lyme Disease Cause Jaundice?

Can Lyme disease cause jaundice? Although uncommon, Lyme disease has been reported to cause hyperbilirubinemia and jaundice in rare cases. Several case reports describe patients who developed severe jaundice before Lyme disease was recognized as the underlying cause.

Lyme disease can affect multiple organ systems. In addition to common symptoms such as fatigue, joint pain, and neurologic problems described in the Lyme disease symptoms guide, rare complications such as jaundice have also been reported.

Two published case reports help answer the question: Can Lyme disease cause jaundice? While uncommon, investigators conclude that hyperbilirubinemia can occur in Lyme disease and should be considered in patients with severe jaundice who have exposure to tick-endemic areas.^1,2

39-Year-Old Man With Fever and Jaundice

Ahmed and colleagues describe the case of a 39-year-old man who was admitted to the hospital with febrile jaundice and diffuse arthralgia.¹ He also had fever, nausea, headaches, and a dry cough for several days.

“His serum metabolic panel was unremarkable except for elevated total bilirubin and creatinine,” the authors write. Common causes of hyperbilirubinemia such as hepatitis A, B, and C were ruled out.

The patient did not recall a tick bite but had recently traveled to Connecticut, USA, an area endemic for Lyme disease.

“Although hyperbilirubinemia is rare in Lyme disease, it should be considered as a differential diagnosis in patients with severe jaundice and a recent history of travel,” writes Ahmed.

Doctors suspected Lyme disease and began empirical doxycycline treatment. Western blot testing later confirmed Lyme disease, and the patient continued doxycycline therapy.

[bctt tweet=”Case reports indicate that although rare, Lyme disease can cause jaundice.” username=”DrDanielCameron”]

The authors conclude that Lyme disease should be considered for patients with severe jaundice who have risk factors for tick exposure, even if the classic erythema migrans rash is absent.

23-Year-Old Camper With Severe Jaundice

Baig and colleagues describe a 23-year-old man who presented to the hospital with severe jaundice, a fever of 102°F, and diffuse arthralgia.

“He was also told he had yellowing of his eyes and skin, which prompted his visit to the Emergency Department,” Baig writes in the case report “Severe Hyperbilirubinemia: A Rare Complication of Lyme Disease.”²

When other causes of jaundice were ruled out, physicians began empirical doxycycline therapy for suspected Lyme disease.

Serologic testing was largely negative except for a positive ELISA screening test for Lyme disease, which was later confirmed by Western blot.

As doxycycline treatment continued, the patient’s bilirubin levels steadily declined.

Can Lyme Disease Cause Jaundice in Rare Cases?

These reports suggest that although uncommon, Lyme disease can cause jaundice and hyperbilirubinemia. Clinicians may consider Lyme disease in the differential diagnosis when patients present with severe jaundice and systemic symptoms, particularly if they live in or have traveled to regions where Lyme disease is common.

Most patients with Lyme disease do not develop jaundice. However, these cases highlight that unexplained hyperbilirubinemia in patients with possible tick exposure may warrant evaluation for Lyme disease.

Because Lyme disease can affect multiple organ systems, atypical presentations such as jaundice may delay diagnosis when clinicians focus only on classic symptoms such as rash or arthritis.

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