Lyme Disease and Long COVID: A Case of Overlapping Symptoms
Symptoms began months after COVID-19 infection
Fatigue, brain fog, and autonomic symptoms developed
Lyme disease was later identified as a contributing factor
The World Health Organization defines Long COVID as symptoms that persist or develop at least 3 months after infection, lasting for at least 2 months and affecting daily function. :contentReference[oaicite:0]{index=0}
Common symptoms include fatigue, shortness of breath, and cognitive dysfunction—features that closely resemble those seen in Lyme disease.
Both conditions can present with relapsing symptoms that fluctuate over time.
A Delayed Onset of Symptoms
A previously healthy 26-year-old medical student contracted COVID-19 early in the pandemic. Her initial illness resolved within two weeks.
Four months later, she developed a new constellation of symptoms:
- Headaches and chest tightness
- Palpitations and tachycardia
- Dizziness and near-syncope
- Blurred vision and fatigue
- Brain fog and memory impairment
These patterns are commonly described in Lyme disease symptoms, particularly in patients with neurologic or autonomic involvement.
Lyme Disease Identified
Testing revealed a positive IgM Western blot consistent with early Lyme disease, while IgG testing was negative.
The patient had increased outdoor exposure during the pandemic, raising the possibility of tick exposure.
She was treated with a two-week course of doxycycline.
Persistent and Worsening Symptoms
Despite treatment, her symptoms not only persisted but intensified:
- Worsening palpitations and near-syncope
- Increased fatigue and heat intolerance
- Visual disturbances and floaters
- Severe headaches with migraine features
- Sleep disturbances and night terrors
This pattern raises the question of whether her symptoms reflected overlapping conditions, incomplete treatment, or a post-infectious inflammatory process.
Autonomic and Neurologic Features
The patient developed symptoms consistent with autonomic dysfunction, including tachycardia and orthostatic intolerance.
These features are commonly seen in autonomic dysfunction in Lyme disease and have also been reported in Long COVID.
She also experienced phantosmia, describing foul smells such as “burning rubber,” suggesting neurologic involvement.
A Complex Recovery
The patient underwent a prolonged recovery involving multiple interventions, including:
- POTS rehabilitation and graded exercise
- Osteopathic manipulative treatment
- Symptom-based management for headaches and nausea
Over time, her symptoms gradually improved, although fluctuations continued.
Diagnostic Uncertainty and Dismissal
Despite her access to care, the patient reported that her symptoms were at times dismissed or attributed to anxiety.
This reflects a broader pattern seen in both Lyme disease and Long COVID, where complex symptom presentations may be misunderstood.
Why This Case Matters
This case highlights the significant overlap between Lyme disease and Long COVID, including:
- Delayed onset of symptoms
- Fatigue and brain fog
- Autonomic dysfunction
- Fluctuating or relapsing course
These similarities are explored further in our Lyme disease and COVID-19 overview.
Co-infections and overlapping conditions should be considered when symptoms persist or evolve beyond the expected course of a single illness.
Start here: Lyme disease symptoms guide
Related Articles:
Podcast: Lyme disease and Long COVID in a 16-year-old girl
References:
- Thor DC, Suarez S. Corona With Lyme: A Long COVID Case Study. Cureus. 2023.
- WHO. Post COVID-19 condition definition. 2021.
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
Sadly familiar. Was she tested for coinfections? It sounds like she had the trifecta: Lyme, Babesia & Bartonella. Heat intolerance, migraine-like headaches, brain fog, palpitations , anxiety – all Babesia symptoms. Floaters, night terrors, phantosmia likely Bartonella symptoms. We need better testing and clinical evaluation of Lyme AND associated coinfections.
I have been treating Lyme disease since 1987. I would not be able to do what I do if I had Lyme disease. bTW I have had patients who have been sick that long.
Thank you for taking the time to respond to my post . Are you still practicing ? I was told that you had retired .
Thanks for asking. I have not retired. That rumor reminds of the quote “The reports of my death are greatly exaggerated” is a popular misquote attributed to author Samuel Clemens, known by his pen name, Mark Twain. The humorous quote is based on a letter Twain sent to a newspaper reporter who had asked Twain about rumors that he was dying” from Dictionary.com I continue to see Lyme disease patients in Mt. Kisco, New York
I’ve had chronic Lyme since 2010. I was vaccinated with the Moderna vaccine in March of 2021. I started getting neurological symptoms that affected my eyes, balance and walking. I was getting a little better, then got Covid in September 2022. This triggered all my chronic symptoms. They were staring to get better until I got Covid in Feb 2024. I though I was over it but in May this year it felt like all my chronic Lyme symptoms were back. Covid and chronic Lyme definitely have a similarity and relationship. I’m still not out of the woods and have to go back to some early Lyme treatments as well as an anti inflammatory diet and meds.
Lyme disease and Long-COVID symptoms can be similar in part due in part to dysautonomia. I have had Lyme disease patients who have flareups from many things including COVID and the COVID vaccine. I advise my patients with a history of chronic symptoms after a COVID vaccine or after COVID to include a Lyme disease evaluation. I have had patients with Lyme disease and long covid