Can Lyme Disease Trigger Sarcoidosis?
Lyme disease may mimic inflammatory disorders.
Researchers have explored a possible sarcoidosis connection.
Neurologic symptoms may complicate diagnosis.
Can Lyme disease trigger sarcoidosis?
Researchers have explored whether infections such as Borrelia burgdorferi, the bacterium associated with Lyme disease, may contribute to inflammatory immune reactions resembling sarcoidosis in selected patients.
Although the relationship remains uncertain, several reports describe patients with overlapping neurologic, inflammatory, and systemic findings.
For a broader overview of neurologic and multisystem Lyme symptoms, visit our Lyme Disease Symptoms Guide.
Case Report Linking Lyme Disease and Sarcoidosis
In a 2018 case report, van Dee and colleagues described a 21-year-old forestry worker with headaches, drooping of the left eyelid, leg swelling, redness, fatigue, weight loss, loss of appetite, and chest discomfort.
Biopsies of lymph nodes and skin demonstrated non-caseating granulomas consistent with systemic sarcoidosis.
The patient also developed involvement affecting the lungs, kidneys, and skin.
Because of his tick exposure history and neurologic symptoms, clinicians pursued evaluation for Lyme disease.
Lyme disease testing was reportedly positive.
The patient was treated with corticosteroids along with intravenous ceftriaxone followed by doxycycline.
According to the authors, the patient improved rapidly after treatment.
Why Lyme Disease May Mimic Autoimmune Disorders
Lyme disease may produce inflammatory, neurologic, rheumatologic, and systemic symptoms that overlap with autoimmune or inflammatory disorders.
Patients with Lyme disease have sometimes initially been diagnosed with:
- Sarcoidosis
- Multiple sclerosis
- Chronic fatigue syndrome
- Fibromyalgia
- Lupus
- Sjögren’s syndrome
Neurologic symptoms, fatigue, pain, and inflammatory findings may complicate diagnosis.
Learn more about Lyme Disease Misdiagnosis.
Possible Immune Mechanisms
Sarcoidosis is characterized by granulomatous inflammation involving organs such as the lungs, lymph nodes, skin, and nervous system.
Researchers have proposed that infections or environmental exposures may sometimes trigger abnormal immune activation in genetically susceptible individuals.
Some investigators have described “Borrelia-like” organisms within biopsy samples obtained from patients with cutaneous sarcoidosis.
However, the exact relationship between Lyme disease and sarcoidosis remains uncertain and controversial.
Neurologic Lyme Disease and Sarcoidosis Overlap
Neurologic Lyme disease and neurosarcoidosis may share overlapping symptoms including:
- Headaches
- Cranial nerve abnormalities
- Fatigue
- Cognitive dysfunction
- Weakness
- Sensory symptoms
- Inflammatory findings on imaging
These similarities may complicate diagnosis, particularly when patients present with multisystem illness.
Learn more about Neurologic Lyme Disease.
Why This Matters Before Immunosuppression
The authors emphasized that clinicians should consider possible infectious triggers before initiating immunosuppressive therapy in patients with new inflammatory disease presentations.
This concern may be especially important when patients have:
- Tick exposure history
- Neurologic symptoms
- Fluctuating multisystem illness
- Fatigue and constitutional symptoms
- Possible Lyme disease exposure risk
Failure to recognize underlying infection before immunosuppression may complicate management in selected patients.
Frequently Asked Questions
Can Lyme disease trigger sarcoidosis?
Researchers have explored whether Lyme disease may contribute to inflammatory immune reactions resembling sarcoidosis in selected patients, but the relationship remains uncertain.
Can Lyme disease mimic sarcoidosis?
Yes. Lyme disease may produce neurologic, inflammatory, and systemic symptoms that overlap with sarcoidosis.
What symptoms overlap between Lyme disease and sarcoidosis?
Symptoms may include fatigue, neurologic abnormalities, pain, inflammatory findings, and multisystem illness.
Why is the overlap important clinically?
Recognizing possible infectious triggers may help clinicians evaluate patients more carefully before starting immunosuppressive therapy.
Is there proof that Lyme disease causes sarcoidosis?
No. Current evidence remains limited and controversial.
Clinical Takeaway
Lyme disease and sarcoidosis may share overlapping inflammatory and neurologic features that complicate diagnosis.
Although evidence remains limited, clinicians may need to consider possible infectious contributors when evaluating patients with new multisystem inflammatory illness before starting immunosuppressive therapy.
Related Articles
Explore autoimmune overlap in Lyme Disease Manifests as Autoimmune Disorder.
Review diagnostic confusion in Lyme Disease Mimics Autoimmune Disorder in Elderly Woman.
Learn more about inflammatory triggers in Can Lyme Disease Trigger an Autoimmune Disease?.
Explore overlapping infections in Lyme Coinfections.
Explore persistent symptoms in Post-Treatment Lyme Disease Syndrome.
References
- van Dee L, Stehouwer M, van Bemmel T. Systemic Sarcoidosis Associated with Exposure to Borrelia burgdorferi in a 21-Year-Old Man. Eur J Case Rep Intern Med. 2018;5(10).
- 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;36(12):1262-1268.
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
I had Sarcoidosis in 1976-77 & Lyme around the same time. Got bit the summer of 76 .
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!!
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.
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!
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.
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?
Great question. I don’t know the answer.
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?
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.
https://www.today.com/health/young-mom-had-heart-transplant-after-lyme-disease-t171329
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 ✨️
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
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.
Regards
Paul
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301890/
Interesting article and comment from Lauren on 16/5/22 . Im also UK based and have just had a Synovectomy of the right middle finger and palm after 9 months of swelling in the tendon and the Histology report from biopsy says Sarcoidosis . I was bitten multiple times by deer ticks on one particular day some 6 months before the tendon swelling started and as there was no bullseye rash at the time of the bites I didn’t seek medical attention and forgot about the incident.
I only thought about Lyme as a cause of the swelling after I then started to experience other symptoms such as stabbing pains in ankles and toes as well as shoulder , wrist and elbow pain . Rheumatologist dismissed any suggestions of Lyme and a one stage basic NHS blood test proved negative for Lyme.
Just yesterday , 9th June 22 , the surgeon who did the synovectomy on my hand broke the news of the sarcoidosis diagnosis and he’s just submitted the histology report to the Rheumatologist who dismissed Lyme so it’ll be interesting to see what he now says when I show him this article, although I suspect he’ll still dismiss the Lyme link .
Hi Dr. Cameron. I was bitten by a tick and contracted HME (ehrlchiosis) but was never told i had lyme. On a recebt blot test.. I had a postive Igm p23ab anitbody but all others were negative. I have all the symptoms of lyme currently . Could i still have chronic lyme?
The tests are not as reliable as I would like. Furthermore, the treatment for Ehrlichia may have interfered with future tests. I advise my patients to use clinical judgement if they remain ill after looking at other illnesses.
Thank you for the reply! I plan on getting the ELISA test today to see if that indicates a positive result for lyme.
Also I had bad nasal sinus polyps and had surgery to remove them. I’m going to have a specialized eye exam.