COVID-19 or Lyme disease triggers autoimmune dysfunction?
Welcome to another edition of Inside Lyme Podcast with Dr. Daniel Cameron. I will be discussing autonomic dysfunction in a 64-year-old woman where COVID-19 or Lyme disease triggered autoimmune dysfunction.
This case was featured in the journal eNeurologicalSci in 2020. According to the author, a 60-year-old woman was diagnosed with Lyme disease based on a tick bite, Bull’s eye rash, joint pain, and swollen lymph nodes. [1] She was treated with a 3-week course of doxycycline.
“Three months later, she experienced headaches, several pain syndromes, disabling fatigue, brain fog, and mood lability,” wrote Novak.
She was then diagnosed with two autonomic disorders. Her distal burning sensation without weakness were diagnosed as small fiber neuropathy (SNF). Her dizziness, brain fog, and fatigue were diagnosed as orthostatic hypoperfusion syndrome (OCHOS).
She continued to suffer from both autonomic issues, despite treatment with rifampin, cefuroxime, and cefdinir. “The autonomic testing findings (SFN and OCHOS) were attributed to Post-Treatment Lyme Disease Syndrome (PTLDS),” wrote Novak. She improved with symptomatic and physical therapy.
IVIG reduces symptoms in COVID-19 and Lyme patient
Four years later, at age 64, she was diagnosed with COVID-19 pneumonia. She was treated with a 5-day course of hydroxychloroquine and azithromycin. She improved to near baseline within a week of treatment.
“Two weeks later she experienced new symptoms such as severe leg pain with burning sensation at feet and hands, twitching and vibration feeling at her face, blurred vision, headaches, brain fog, forgetfulness, chronic fatigue, orthostatic dizziness and urinary incontinence but no weakness or dyspnea,” wrote Novak.
She was diagnosed clinically with autonomic disease as the testing could not be performed due to COVID-19 related safety restrictions.
She improved with immunotherapy with IVIG. Immunotherapy successfully resolved her leg pain, brain fog, urinary problems, and blurred vision. Her headaches and chronic fatigue improved by about 50%.
Author concludes: COVID-19 infection triggered autoimmune reaction.
Editor’s note: I would have questioned whether the autonomic dysfunction was related to COVID-19 or Lyme disease. Fortunately, the 64-year-old woman with a history of headaches, hypothyroidism, and autonomic dysfunction from PTLDS was able to recover from COVID-19.
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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.
Alan Whitman
01/07/2022 (6:13 am)
In cases of autoimmune dysfunction and perhaps in other Lyme cases, what is the advisability of treating with prednisone?
Dr. Daniel Cameron
01/07/2022 (9:47 am)
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.
Elizabeth Holt
01/01/2022 (1:46 pm)
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.
Mark
11/28/2021 (7:33 pm)
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?
Dr. Daniel Cameron
11/29/2021 (7:27 am)
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.
Jean P Lozoraitis
03/31/2021 (8:15 am)
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.
Dr. Daniel Cameron
04/01/2021 (8:23 am)
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.
Frances Locastro
01/30/2021 (12:11 pm)
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.
Dr. Daniel Cameron
01/30/2021 (1:12 pm)
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.
TLK
01/30/2021 (3:30 pm)
Reply to F Locastro: Bartonella? Best lab for Bartonella test is Galaxy Labs of North Carolina. It takes approximately 3 weeks for results.