Can Lyme disease cause jaundice?

Gastrointestinal complications are often seen in Lyme disease. But hyperbilirubinemia, a condition that causes yellow discoloration of the eyes and skin, referred to as jaundice, is a rare manifestation of Lyme disease. Only a handful of cases have been reported in the literature. 

Two recently published case reports address the question: Can Lyme disease cause jaundice?  While it is uncommon, the authors conclude, hyperbilirubinemia can be a sign of Lyme disease, and should be considered as a differential diagnosis in patients with severe jaundice and exposure to areas endemic for Lyme disease. ^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 a 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, and “common causes of hyperbilirubinemia such as hepatitis A, B, and, C were negative.”

The man 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 presumed that Lyme disease might be causing jaundice in their patient. He was started empirically on doxycycline. When Western blot test results returned, Lyme disease was confirmed and the man continued on doxycycline for treatment.

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While it is rare, Ahmed et al. conclude that Lyme disease can, in fact, cause jaundice. “Lyme disease should be considered for any patient with severe jaundice, significantly in those patients who are at risk of severe infection and have recently traveled to an endemic area, regardless of the presence of a rash.”

23-year-old camper with severe jaundice 

Meanwhile, Baig et al. describe a 23-year-old man who presented to the hospital with severe jaundice, a fever of 102.02°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 all other etiologies were ruled out, the man was started on empirical doxycycline for presumed Lyme disease, which doctors believed was causing jaundice.

“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 on doxycycline continued, the man’s bilirubin levels steadily declined.

The authors suggest: “Lyme disease should be considered in the differential diagnosis of hyperbilirubinemia, particularly in patients who are at risk of severe infection and end organ damage and are living in an endemic area or have recently traveled to an endemic area, regardless of the presence of a rash.”