Lyme Disease and Long COVID Symptoms: A Case Study

Lyme disease and Long COVID symptoms can overlap
Brain fog, fatigue, and dysautonomia may complicate diagnosis
Careful evaluation may identify overlapping illnesses

The overlap between Lyme disease and Long COVID symptoms has become increasingly difficult for clinicians and patients to navigate. Fatigue, cognitive dysfunction, dizziness, palpitations, and exercise intolerance are frequently reported in both conditions.

Patients often ask whether COVID triggered Lyme disease, unmasked underlying illness, or created a second overlapping condition. Although these questions remain incompletely answered, case reports continue to highlight important similarities.

These overlapping symptoms often extend beyond infection alone and may involve autonomic dysfunction, neuroinflammation, and prolonged recovery patterns similar to those described in autonomic dysfunction in Lyme disease and brain fog in Lyme disease.

A published case report illustrates how challenging this overlap can become in clinical practice.

Symptoms Appeared Four Months After COVID-19

A previously healthy 26-year-old medical student contracted COVID-19 early in the pandemic. Her initial illness resolved after approximately two weeks.

Four months later, she developed headaches, chest tightness, palpitations, anxiety, dizziness, near-syncope, blurred vision, fatigue, cognitive dysfunction, appetite loss, diarrhea, heat intolerance, and diffuse muscle pain. :contentReference[oaicite:0]{index=0}

The broad symptom pattern mirrors complaints commonly seen in both Long COVID and patients with persistent Lyme disease symptoms.

Lyme Disease Testing Was Positive

Testing revealed a positive IgM Western blot while IgG testing remained negative. Given increased outdoor exposure during pandemic distancing, Lyme disease became a diagnostic consideration. Coinfection testing was reportedly normal. She received two weeks of doxycycline. :contentReference[oaicite:1]{index=1}

Despite treatment, symptoms worsened.

She developed worsening palpitations, blurred vision, heat intolerance, near-syncopal episodes, headaches, nausea, scalp allodynia, sleep disruption, and night terrors. These worsening symptoms complicated efforts to determine whether Lyme disease, Long COVID, autonomic dysfunction, or overlapping mechanisms were driving illness.

Could This Have Been a Herxheimer Reaction?

The authors did not specifically discuss whether symptom worsening following antibiotics reflected a Jarisch-Herxheimer reaction.

However, temporary symptom flares following treatment remain a consideration in some Lyme disease patients and can further complicate interpretation of treatment response.

Patients interested in symptom flares and treatment reactions may also relate to discussions around Herxheimer reactions in Lyme disease.

Changes in Smell and Sensory Processing

The patient developed altered smell perception after COVID infection.

She initially experienced temporary anosmia and ageusia during acute COVID infection. Later, she reported significant phantosmia, describing foul smell distortions involving foods, perfumes, and body odors. :contentReference[oaicite:2]{index=2}

These sensory disturbances reinforce how neurologic symptoms may extend beyond fatigue and brain fog.

POTS Rehabilitation and Gradual Recovery

Over time, the patient underwent extensive evaluation.

Her pulmonary testing remained normal. She participated in POTS rehabilitation, graded exercise, osteopathic manipulative treatment, sleep interventions, and symptom-based management. Gradual improvements followed, although recovery remained prolonged. :contentReference[oaicite:3]{index=3}

These experiences resemble recovery challenges frequently discussed in recovery from Lyme disease.

The Role of Medical Dismissal

One important aspect of this case involved delayed recognition.

The authors noted that despite being medically literate and having healthcare access, the patient repeatedly encountered clinicians who attributed symptoms to anxiety or dismissed complaints. :contentReference[oaicite:4]{index=4}

Diagnostic uncertainty remains common when illnesses produce overlapping symptoms across multiple organ systems.

Frequently Asked Questions

Can COVID trigger Lyme disease symptoms?

COVID infection may overlap with Lyme disease symptoms or potentially unmask underlying illness patterns, though mechanisms remain unclear.

Do Lyme disease and Long COVID share symptoms?

Yes. Fatigue, cognitive dysfunction, dizziness, palpitations, sleep disruption, and exercise intolerance commonly overlap.

Can Lyme disease cause POTS symptoms?

Some Lyme disease patients report autonomic symptoms including dizziness, tachycardia, near-syncope, and exercise intolerance.

Can Lyme disease affect smell or taste?

Altered smell and sensory symptoms have been described, though COVID itself remains a common cause.

Why is Lyme disease sometimes mistaken for Long COVID?

Both illnesses may involve fluctuating symptoms affecting multiple systems, making diagnosis challenging.

Clinical Takeaway

Lyme disease and Long COVID symptoms overlap across neurologic, autonomic, and cognitive domains.

Careful history-taking, symptom pattern recognition, and evaluation for overlapping illnesses may improve diagnostic accuracy.

Persistent symptoms after COVID should not automatically exclude the possibility of Lyme disease or other overlapping conditions.

Related Articles

These articles explore overlapping neurologic symptoms, autonomic dysfunction, and recovery challenges.

Lyme and Long COVID Brain Fog
Post-Treatment Lyme Disease Syndrome
Lyme Disease Misdiagnosis
Coinfections in Lyme Disease

References

1. Thor DC, Suarez S. Corona With Lyme: A Long COVID Case Study. Cureus. 2023;15(3):e36624.
2. World Health Organization. A Clinical Case Definition of Post COVID-19 Condition by a Delphi Consensus. 2021.

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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