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.  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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- 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.