COVID-19 or Lyme Disease Triggering Autoimmune Dysfunction?
Welcome to another edition of the Inside Lyme Podcast with Dr. Daniel Cameron. In this episode, I discuss a case of autonomic dysfunction in a woman with a history of Lyme disease who later developed COVID-19. The case raises an important clinical question: did COVID-19 or Lyme disease trigger autoimmune dysfunction?
This case was featured in the journal eNeurologicalSci. According to the report, a woman was initially diagnosed with Lyme disease after experiencing a tick bite, a bull’s-eye rash, joint pain, and swollen lymph nodes. [1] She was treated with a three-week course of doxycycline.
Three months later, she developed persistent symptoms including headaches, widespread pain, disabling fatigue, brain fog, and mood lability.
She was subsequently diagnosed with two autonomic disorders. Her burning sensations in the feet and hands without weakness were attributed to small fiber neuropathy (SFN). Her dizziness, fatigue, and cognitive difficulties were diagnosed as orthostatic cerebral hypoperfusion syndrome (OCHOS).
Despite treatment with rifampin, cefuroxime, and cefdinir, her autonomic symptoms persisted. Novak attributed the autonomic findings to post-treatment Lyme disease syndrome (PTLDS). She experienced partial improvement with symptomatic therapy and physical rehabilitation.
IVIG reduces symptoms in COVID-19 and Lyme patient
Four years later, at age 64, she developed COVID-19 pneumonia and was treated with hydroxychloroquine and azithromycin. Within one week she improved to near baseline.
However, two weeks later she developed new symptoms including severe leg pain, burning sensations in the hands and feet, facial twitching, vibration sensations, blurred vision, headaches, brain fog, memory problems, chronic fatigue, orthostatic dizziness, and urinary incontinence.
Because of COVID-19 safety restrictions, formal autonomic testing could not be performed. Based on her clinical presentation, physicians diagnosed recurrent autonomic dysfunction.
She was treated with immunotherapy using intravenous immunoglobulin (IVIG). The treatment significantly improved several symptoms, including leg pain, brain fog, urinary problems, and blurred vision. Her headaches and chronic fatigue improved by approximately 50%.
Author concludes: The COVID-19 infection triggered an autoimmune reaction.
Editor’s note: I would have questioned whether the autonomic dysfunction was related to COVID-19 or Lyme disease. The patient had a prior history of headaches, hypothyroidism, and autonomic dysfunction attributed to PTLDS. Fortunately, she recovered from the acute COVID-19 infection.
For a comprehensive overview of the Long COVID and Lyme disease connection—including my peer-reviewed research involving 889 patients—see Long COVID and Lyme Disease: What Patients Need to Know.
To learn more about how Lyme disease affects the autonomic nervous system, see Autonomic Dysfunction and Lyme Disease.
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Long COVID and Lyme Disease: What Patients Need to Know
References
- Novak P. Post-COVID-19 syndrome associated with orthostatic cerebral hypoperfusion syndrome, small fiber neuropathy and benefit of immunotherapy: a case report. eNeurologicalSci. 2020;21:100276.
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
Hello Dr. Cameron, I’m originally from Syracuse New York but now live in Boise Idaho. I’ve gone to dozens and dozens of doctors and in 2020 was in the hospital four times with every symptom of covid but they diagnosed me with pericarditis.They called in infectious disease doctors at the time finally. But my test did not show Lyme disease according to them. The reason I write you is that I am feeling near death have been suffering with the severe painful burning sweating condition, severe muscle and joints pain which makes me feel paralized. I believe is caused by Lyme disease. I’ve seen dozens of doctors but I believe they’re missing something here. How do I go about contacting you. I am 67 years old, and test showed that I tested positive for lyme disease years ago but many doctors said no it was not active. I can explain details more as how do I get to see you. I can barely move or walk. The neurologist is considering autonomic disease as the small fiber neuropathy tested negative. My phone number is 208-505-7567.
I have patients in my practice with similar concerns. I typically look for Babesia if there are sweats and unresolved symptoms after an extensive evaluation. I often have seen autonomic issues in my patients. Give my office a call at 914-666-4665 if you have any questions.
Reply to F Locastro: Bartonella? Best lab for Bartonella test is Galaxy Labs of North Carolina. It takes approximately 3 weeks for results.
Hello..need to know something. I have history of Lyme Disease, battling symptons for decades. I am 70. I just got my first covid vaccine two and one half weeks ago. About 5 days ago, I got bitten by another tick. Symptoms came rushing in. Found an informed physician;s assistant who gave me 21 day supply of doxy. Surprisingly, the doxy isn’t significantly reducing symptoms. I want to know if the vaccine can stimulate the immune system so it is working overtime, responding to new infection in body, and possibly attacking healthy cells? I am afraid to get the second dose.Am feeling really sick despite the treatment. This is unusual for me. I usually respond quickly to antibiotics. Every doctor I talk to says there shouldn’t be any problem taking vaccine if you have or had Lyme.
I would have the same questions. Lyme disease, COVID-19 and the vaccine affect the immune system. I am happy the doctor recognized and treated your Lyme disease. I tend to favor completion of the vaccine due to the severity of COVID-19 in some individuals. My patients have tolerated the vaccine. I have some readers who have not. You will have to work with your doctor to help you make a decision.
I am currently 43 years old.
I was diagnosed with Lyme disease in September 2017. I took Doxy And the symptoms cleared up after a day or two. I was on a 21 day course.
January 2020. I was at the gym riding an exercise bike and reading a book. I felt a little pressure at the top of my kneecap.My right knee filled up with a lot of fluid. I played college football and they thought it was kneecap arthritis and tendinitis. The swelling lasted for 15 weeks and eventually went away. They did not drain my knee or put me on any medicine.
October 2021. I was at the gym doing light leg press. My knee became irritated at the top of the kneecap. It filled up with fluid. I had it drained five times. The synovial fluid was dark yellow when they drained it. I had an MRI and an x-ray completed. They also scoped my knee last week. They said overall the scope was pretty clean and the mri looked pretty good overall. He had to clean up my meniscus a little bit. However, the doctor said the swelling wouldn’t be that much from the meniscus. The lining of my knee is very swollen.
I do not have any other symptoms. I am not tired and I don’t have any other pain.
What are your thoughts?
Lyme disease was first described as knee swelling. I have Lyme disease patients in my practice with recurrent synovitis of the knee. Their synovitis can lead to significant knee swelling. I advise my patients to work with their orthopedist but to also look again at Lyme disease.
I am currently 43 years old.
I was diagnosed with Lyme disease in September 2017. I took Doxy And the symptoms cleared up after a day or two. I was on a 21 day course.
January 2020. I was at the gym riding an exercise bike and reading a book. I felt a little pressure at the top of my kneecap.My right knee filled up with a lot of fluid. I played college football and they thought it was kneecap arthritis and tendinitis. The swelling lasted for 15 weeks and eventually went away. They did not drain my knee or put me on any medicine.
October 2021. I was at the gym doing light leg press. My knee became irritated at the top of the kneecap. It filled up with fluid. I had it drained five times. The synovial fluid was dark yellow when they drained it. I had an MRI and an x-ray completed. They also scoped my knee last week. They said overall the scope was pretty clean and the mri looked pretty good overall. He had to clean up my meniscus a little bit. However, the doctor said the swelling wouldn’t be that much from the meniscus. The lining of my knee is very swollen.
I do not have any other symptoms. I am not tired and I don’t have any other pain.
What are your thoughts?
R. Todd Holt has been suffering from Lyme Disease now for 25 years. He now has, what is called Chronic Lyme Disease. His most productive treatment in mid 2021was in taking a new drug/antibiotic called “Disulfiram.” Todd was taking it for 3 weeks, and was already noticing an improvement in his health. Unfortunately, he was allergic to the “sulfa” in this drug and had to end treatment. I understand there are another 2 drugs new, also, on the market: Azlocillin and Cefotaxime. We do not know how to continue our search for the drug/antibiotic that will aid in helping to mange or cure Lyme disease. Todd has tried every other antibiotic being used for Lyme – through his plight of 25 years. His doctor has recently retired.
In cases of autoimmune dysfunction and perhaps in other Lyme cases, what is the advisability of treating with prednisone?
I try to avoid steroids in tick borne infections so as not to suppress the immune system during an infection. There are illnesses where steroids can not be avoided.