Can Lyme Disease Cause Jaundice?
Jaundice is an uncommon manifestation of Lyme disease
Elevated bilirubin and liver abnormalities have been reported
Diagnosis may require ruling out more common causes first
Can Lyme disease cause jaundice? Although uncommon, case reports suggest Lyme disease can lead to hyperbilirubinemia, jaundice, and abnormal liver tests in select patients. Clinicians may need to consider Lyme disease when patients present with unexplained jaundice and compatible exposure history.
Two published case reports address this question directly. Authors conclude that although rare, hyperbilirubinemia can be a manifestation of Lyme disease and should remain in the differential diagnosis in patients with severe jaundice and exposure to endemic regions.
39-Year-Old Man With Fever and Jaundice
Ahmed and colleagues describe a 39-year-old man admitted to the hospital with febrile jaundice and diffuse arthralgia.
He also experienced 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, while common causes of hyperbilirubinemia including hepatitis A, B, and C were negative.
The man did not recall a tick bite but had recently traveled to Connecticut, 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,” Ahmed and colleagues conclude.
Doctors empirically started doxycycline while awaiting testing. When Western blot results returned positive, Lyme disease was confirmed and treatment continued.
23-Year-Old Camper With Severe Jaundice
Baig and colleagues describe a 23-year-old man who presented with severe jaundice, diffuse arthralgia, and a fever of 102°F.
“He was also told he had yellowing of his eyes and skin, which prompted his visit to the Emergency Department,” the authors explain.
When alternative causes were excluded, physicians initiated doxycycline for presumed Lyme disease.
“Serum screening tests were predominantly negative except for a positive ELISA screen for Lyme disease, which was subsequently confirmed by Western blot,” the authors write.
As treatment continued, bilirubin levels steadily improved.
Can Lyme Disease Cause Elevated Liver Enzymes?
Mild liver enzyme abnormalities may occur more commonly than jaundice itself. Elevated AST, ALT, alkaline phosphatase, or bilirubin levels have been described in Lyme disease and may complicate diagnosis.
Because abnormal liver tests can occur with viral hepatitis, medications, alcohol use, coinfections, and other illnesses, clinicians generally maintain a broad differential diagnosis.
For overlap with other tick-borne illnesses, see tick-borne coinfections.
Can Lyme Disease Affect the Liver?
Lyme disease primarily affects the skin, joints, nervous system, and heart, but liver involvement has also been reported.
Most patients with liver abnormalities have mild elevations in liver enzymes rather than severe jaundice.
Rare complications involving hyperbilirubinemia or significant liver dysfunction have been described in case reports, but these presentations remain uncommon.
What Else Can Cause Jaundice in Lyme-Endemic Areas?
Jaundice has many causes, making diagnosis challenging.
- Viral hepatitis
- Gallbladder disease
- Alcohol-related liver disease
- Medication reactions
- Hemolysis
- Tick-borne coinfections
Clinicians often need to exclude more common causes before attributing jaundice to Lyme disease.
Why Lyme-Related Jaundice May Be Missed
Lyme-related jaundice can be overlooked because:
- Jaundice is an uncommon presentation
- Patients may not recall a tick bite
- Rash may be absent
- Liver disease is often investigated first
- Symptoms overlap with other infections
For diagnostic challenges, see delayed Lyme disease diagnosis.
Frequently Asked Questions
Can Lyme disease cause jaundice?
Yes. Although uncommon, case reports suggest Lyme disease may occasionally cause jaundice or hyperbilirubinemia.
Can Lyme disease affect the liver?
Yes. Mild liver abnormalities have been reported, although severe liver complications appear uncommon.
Can Lyme disease cause elevated liver enzymes?
Yes. Elevated liver enzymes have been described in Lyme disease but should prompt evaluation for multiple causes.
Can Lyme disease cause liver failure?
Severe liver complications appear rare. Other causes should also be carefully investigated.
Why does Lyme disease sometimes cause yellow skin?
Yellow skin or jaundice may occur when bilirubin levels rise, though this remains an uncommon manifestation of Lyme disease.
Clinical Takeaway
Jaundice is not a common presentation of Lyme disease, but published cases suggest it can occur. Liver abnormalities, hyperbilirubinemia, and yellowing of the skin should prompt evaluation for more common causes while maintaining awareness of unusual tick-borne presentations.
In patients with jaundice, compatible symptoms, and exposure risk, Lyme disease may occasionally deserve consideration in the differential diagnosis.
Related Articles
These related articles explore overlapping symptoms, diagnostic challenges, and recovery issues associated with Lyme disease.
Post-treatment Lyme disease syndrome
Gastrointestinal Lyme disease
Lyme disease misdiagnosis
Recovery from Lyme disease
Neurologic Lyme disease
References
- Ahmed Z, Ur Rehman A, Awais A, Hanan A, Ahmad S. Lyme Disease and Severe Hyperbilirubinemia: A Rare Presentation of Lyme Disease. Cureus. 2020;12(5):e8363.
- Baig M, Zheng L, Farmer A. Severe Hyperbilirubinemia: A Rare Complication of Lyme Disease. Case Rep Gastrointest Med. 2019;2019:2762389.
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
