Sarcoidosis triggered by Lyme disease

examing lung x-ray of man with sarcoidosis and Lyme disease

Sarcoidosis is an inflammatory disease that affects multiple organs in the body, typically the lungs and lymph glands. The exact cause of sarcoidosis is unknown. But some researchers believe it may be a type of autoimmune disease, involving an abnormal immune response.

According to the American Lung Association, an “infection or exposure to something in the environment can trigger the immune system to overreact,” resulting in sarcoidosis.¹ In a 2018 study, van Dee and colleagues suggest that Borrelia burgdorferi, the Lyme disease bacterium, may be one of those infectious pathogens capable of triggering sarcoidosis. ²

Their study entitled “Systemic Sarcoidosis Associated with Exposure to Borrelia burgdorferi in a 21-Year-Old Man” describes the case of a 21-year-old forestry worker who was admitted to the emergency department with a history of headaches, a droopy left eyelid and swelling and redness of both legs.

The patient also had “a stinging pain behind his sternum, fatigue, weight loss, loss of appetite, thirst and nycturia,” the authors wrote.

Results from lymph node and skin biopsies indicated non-caseating granuloma, leading to a diagnosis of systemic sarcoidosis. The condition had impacted the man’s lungs, kidneys and skin.

[bctt tweet=”Lyme disease triggers sarcoidosis, an inflammatory disorder that usually affects the lungs and lymph glands. ” username=”DrDanielCameron”]

Following the sarcoidosis diagnosis, a spinal tap for Lyme disease was performed based on the patient’s exposure to ticks as a forestry worker and his symptoms.

Lyme disease test results were positive. He was treated with a combination of high-dose prednisolone and antibiotics. He also received 2 weeks of intravenous ceftriaxone followed by 4 weeks of oral doxycycline.

“The patient recovered quickly within a few days of starting a high-dose prednisolone regime, and was discharged free of symptoms and in good health,” the authors wrote

Additionally, “Borrelia-like” organisms have been described within biopsy specimens in patients with cutaneous sarcoidosis, according to a 2009 study.³

“Usually single spirochetes, rarely pairs or small clusters of bacteria were observed between collagen bundles or at the periphery of granulomas,” the authors wrote


Clinicians “should maintain a high index of suspicion for underlying infectious processes like neuroborreliosis in patients with new-onset sarcoidosis before starting immunosuppressive regimens,” van Dee suggests.

UPDATED: June 30, 2021

  1. American Lung Association.
  2. van Dee, L., Stehouwer, M., & van Bemmel, T. (2018). Systemic Sarcoidosis Associated with Exposure to Borrelia burgdorferi in a 21-Year-Old Man. European Journal of Case Reports in Internal Medicine, 5(10).
  3. Derler AM, Eisendle K, Baltaci M, Obermoser G, Zelger B. High prevalence of ‘Borrelia-like’ organisms in skin biopsies of sarcoidosis patients from Western Austria. J Cutan Pathol. 2009 Dec;36(12):1262-8. doi: 10.1111/j.1600-0560.2009.01271.x. PMID: 19469874.

24 Replies to "Sarcoidosis triggered by Lyme disease"

  • lauren
    05/16/2022 (12:25 am)

    this is interesting i was bitten by something we were in the woods(i now presume a tick) and had a bulls eye rash on my arm. was on holiday at the time so waited till back in the uk and went to my doctors. was not tested for lyme disease and basically told it was nothing set home with some cream. fast forward two years and i was diagnosed with sarcoid after Lymphadenopathy of the mediastinal which presented on x-ray, extreme fatigue and swollen painful joints. i am starting to feel the two are connected

    • Paul Armstrong
      09/13/2022 (2:17 am)

      Lauren ,
      Please see above comment from me regarding me also getting tick bites and subsequently getting a sarcoidosis result from biopsy some 18 months after the bites .
      Again, it was swollen joints that led to the eventual Sarc diagnosis.

  • Paula Clarke
    07/14/2021 (4:15 pm)

    I had a left frozen shoulder in 2018, then bilateral facial palsy in sept and Dec 2019, followed by severe headaches for months which then resided, leaving me with dry/burning eyes, dry nose and mouth and reduced taste. Followed by muscle and joint pain all over and and now a right side frozen shoulder and another facial palsy last week. I had a Lyme disease test which was negative, and bloods for sjogrens, thyroid and sarcoidosis which we’re all negative.

    A rheumatologist referred me for a Gallium scan which shows inflammation of all the joints, lacrimal gland and nasopharynx. Lymph nodes ok, chest X-ray clear and no skin lesions and no where to take a biopsy from. They seem to think I have sarcoidosis and are treating me as such with hydroxychloroquine.

    However, I’m concerned that I’m still unwell, and various people I know keep telling me to have a different test done for Lyme disease saying that the blood tests don’t always pick it up. Is that correct?
    Is there another test for lyme disease ?

    Does it sound like I should be Re tested?

    • Dr. Daniel Cameron
      07/15/2021 (6:12 am)

      Bilateral Bell’s palsy followed by symptoms have been seen in Lyme disease. The tests for tick borne illness can be negative and still have the disease.

    • Kristine
      06/21/2022 (8:40 am)

      Lyme test are unreliable, 50% chance of false negative or positive. Really don’t know why they use them at all. Clinical diagnosis by a LLMD is best for you and then treatment. Anyone else Really don’t know what they’re doing. Most important, stay positive ✨️

      • Zippster
        07/01/2023 (6:10 am)

        Lyme test – Does not work : PCR Test – Does not work. See a pattern ?

  • Tamar Cerafici
    05/22/2021 (12:55 pm)

    I’ve had Lyme symptoms since 2016 (negative tests & no rash); in October 2019, I was treated for an active infection (erythema migrants, but negative test). In early 2020 I was diagnosed with PLDTS, and sent on my way. In November of 2020, I started reliving sxs of active Lyme. Both Lyme and Covid tests negative. Since then, the cramps and muscle fatigue have continued as has my dry hacking cough. These briefly responded to antibiotics and prednisone, but returned once the Tx ended. Currently my lung function is at 49%. Lung X-rays are clear, and echocardiogram revealed to damage. Two other family members are currently being treated for sarcoidosis and I had erythema nodosa and lymph swelling throughout my teens and 20s. Could the lung issues be a resurgence of sarcoidosis triggered by the Lyme?

  • Sheryl
    03/07/2021 (2:49 am)

    Interesting article. I looked it up because I was bitten by a tick in 1992, resulting in positive Lyme titre & negative syphilis test (since they’re caused by the same spirochete) & back then, syphilis test was more accurate. I had 3 week course of Doxy but that’s it & I had no symptoms except for the ‘target’ sore behind my knee. Fast forward abt 12 years, when I was exposed in an apartment to probably several different types of mold! It was disgusting! I got out of that apartment, but shortly after, I tested positive for Sarcoidosis with ACE, ANCA, CRP and renal & lymph node biopsies AFTER having a biopsy; chemo for breast cancer. My sxs can be severe at times but because of CKD, my choices of Tx are very limited.
    Nobody in my paternal or maternal family had breast cancer except my paternal great grandmother that died from it. From all of my researching, I am curious as to if the mold exposure was the culprit. However, I am unable to find much on that combo.
    Any thoughts?
    Thank you!

    • Dr. Daniel Cameron
      03/07/2021 (9:02 am)

      I have not found sufficient published information to address your Mold question. I am curious as to whether Lyme disease was adequately treated. For now, you will have to rely on a rheumatologist.

  • Barb thibodeau
    02/07/2020 (8:31 am)

    I had Sarcoidosis in 1976-77 & Lyme around the same time. Got bit the summer of 76 .

    • Jillian Hontz
      10/08/2020 (7:17 pm)

      Interesting article Thank you, Dr. Since this is an autoimmune disease article I would like to know if you have information on the significance of a very elevated (1280 titer) antinuclear antibodies test along with a very elevated C4a of 1680. From what I understand the antibodies are inside of the nucleus which is probably not I good. The neuromuscular doctor that ordered the ANA profile is far from lyme literate.

      Dr. Cameron I would very much appreciate your insight. I was treated two weeks after my known tick bite that was on me approximately 53 hours Treated over phone consult at beginning of Covid for 3 weeks. I slipped through the cracks on follow up. Did not know that I should have been seen after completing Doxy, especially with new symptoms occurring on Day 11 and continuing for now 7 months. My initial presenting symptoms were always mild.

      Then through learning about Lyme and coinfections and all that goes along with a bite , I Learned that the new symptoms that started on day 11 of Doxy is small fiber neuropathy . It’s not anything that I cannot deal with, but I have the concerns that the antibodies are within the nucleus of my cells with a high titer! And the added fact of the very elevated C4a I haven’t seen mention on your threads about this type of thing and whether my immune system is still capable of correction with the antibodies INSIDE of the cells. I would very much appreciate any insight you could give me regarding this, Dr!!

      • Dr. Daniel Cameron
        10/09/2020 (8:06 am)

        I find a C4a can show inflammation but not the cause of the inflammation. An ANA can be elevated from many causes. You many never find a cause for the ANA elevation. I have not heard that an ANA reflects antibodies in the nucleus. You will have to be evaluated or other causes. For example, you would need to see a neurologist to address your concerns with small fiber neuropathy.

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