Can Lyme Disease Be Misdiagnosed as Long COVID?
Lyme disease may be misdiagnosed as Long COVID
Both illnesses can produce overlapping symptoms
The correct diagnosis may change treatment options
Can Lyme disease be misdiagnosed as Long COVID? Yes. Lyme disease and Long COVID can both involve fatigue, brain fog, dizziness, pain, sleep disruption, autonomic symptoms, and exercise intolerance. However, these similarities do not make the conditions interchangeable, and some patients may have both.
Since the pandemic, I have evaluated patients whose persistent symptoms were initially attributed entirely to Long COVID but whose subsequent clinical assessment raised concern for another illness.
One patient was told that her fatigue, brain fog, dizziness, and poor sleep represented lingering viral effects. However, she was not improving, and aspects of her history and clinical presentation justified a broader evaluation.
Her subsequent assessment raised concern for Lyme disease symptoms rather than Long COVID alone. The diagnostic question is not always either-or because Lyme disease and Long COVID can coexist.
That distinction may change the evaluation, treatment options, and expectations for recovery.
Why Lyme disease can be mistaken for Long COVID
Both Lyme disease and Long COVID can produce persistent or fluctuating symptoms involving cognition, energy, pain, sleep, autonomic function, and quality of life.
- Brain fog and slowed processing
- Persistent fatigue
- Dizziness or lightheadedness
- Rapid heart rate or palpitations
- Mood changes
- Musculoskeletal or nerve pain
- Exercise intolerance
- Post-exertional worsening of symptoms
- Poor or unrefreshing sleep
Both conditions may also involve autonomic dysfunction. This can contribute to dizziness, palpitations, changes in heart rate, gastrointestinal symptoms, and difficulty tolerating standing or physical activity. Similar symptoms may occur with autonomic dysfunction associated with Lyme disease.
No single symptom reliably distinguishes Lyme disease from Long COVID. The timing of the illness, exposure history, symptom pattern, objective findings, and appropriate laboratory testing all matter.
Clues that may help distinguish Lyme disease from Long COVID
Long COVID is a chronic condition that develops after SARS-CoV-2 infection and is present for at least three months. A previous positive COVID-19 test can support the history, but it is not required because some people were never tested or did not recognize their initial infection.
Features that may support Long COVID include:
- Symptoms that began during or after a probable SARS-CoV-2 infection
- Loss or alteration of taste or smell
- Persistent cough, shortness of breath, or other respiratory symptoms
- Post-exertional malaise beginning after COVID-19
- Symptoms that emerged, persisted, or returned following the acute infection
Features that may raise concern for Lyme disease or another tick-borne illness include:
- Symptoms that began before the suspected COVID-19 infection
- Residence in or travel to an area where Lyme disease is common
- Outdoor activity or another opportunity for tick exposure
- An expanding erythema migrans rash
- Facial palsy, meningitis, radicular pain, carditis, or objective joint swelling
- Migratory pain or a symptom pattern that does not fit the presumed post-viral course
- Night sweats, chills, anemia, low platelet counts, or other findings that justify evaluation for a coinfection
These clues are not diagnostic by themselves. Many people with Lyme disease do not remember a tick bite, and an erythema migrans rash is not always noticed. Conversely, persistent fatigue, brain fog, dizziness, or pain alone does not establish Lyme disease.
The risks of mislabeling persistent symptoms
Recognition of Long COVID has helped validate the experiences of people with persistent and disabling symptoms. However, any diagnostic label can narrow clinical thinking if it is accepted before other reasonable explanations have been considered.
When symptoms are automatically attributed to Long COVID, important questions may not be asked:
- Did the symptoms clearly follow a documented or probable SARS-CoV-2 infection?
- Did any symptoms begin before COVID-19?
- Was there a plausible opportunity for tick exposure?
- Were objective manifestations of Lyme disease considered?
- Was Lyme testing performed at an appropriate time and interpreted in its clinical context?
- Do the history, symptoms, or laboratory findings justify targeted testing for another tick-borne infection?
- Were other medical explanations for the symptoms evaluated?
I have evaluated patients whose persistent symptoms were initially attributed entirely to Long COVID but whose subsequent assessment raised concern for Lyme disease or another tick-borne illness. In selected patients, addressing the newly identified condition was followed by improvement.
This does not mean that persistent symptoms after COVID-19 are usually caused by Lyme disease or that improvement proves the original diagnosis was incorrect. It means that clinicians should remain willing to revisit the differential diagnosis when the clinical course does not fit.
How I evaluate possible Lyme disease misdiagnosed as Long COVID
When persistent symptoms do not fit the expected clinical history, I broaden the differential diagnosis rather than relying on the symptom list alone.
- Establish whether symptoms followed a documented or probable SARS-CoV-2 infection
- Review the timing and sequence of every major symptom
- Assess tick exposure, outdoor activity, travel, season, and geographic risk
- Look for objective manifestations associated with Lyme disease
- Review the timing, type, and limitations of previous Lyme disease testing
- Consider targeted evaluation for tick-borne coinfections when supported by the history, symptoms, or laboratory findings
- Evaluate other causes of fatigue, cognitive problems, dizziness, pain, and exercise intolerance
- Reconsider earlier diagnoses when the illness persists, changes, or no longer fits the available evidence
Lyme testing should be interpreted in relation to the stage of illness and the patient’s clinical presentation. Testing performed too early may be negative before a detectable antibody response develops. At the same time, negative testing should not simply be dismissed, and persistent nonspecific symptoms alone should not be considered proof of Lyme disease.
Research into distinguishing the two conditions
A 2024 study involving 347 individuals evaluated a machine-learning model that used cytokine patterns to distinguish participants classified as having Long COVID from those classified as having chronic Lyme disease.
In the study, the chronic Lyme group had symptoms that predated the COVID-19 pandemic, persisted for more than six months, and had Lyme disease confirmed through two-tier antibody testing. The investigators also evaluated the model in a separate random sample containing 106 participants with Long COVID and 18 with chronic Lyme disease.
The results support the possibility that immune-marker patterns may eventually help differentiate clinically overlapping conditions. However, the model requires additional independent validation and is not a standard clinical diagnostic test.
For a broader discussion of the clinical overlap and my cross-sectional survey involving 889 participants with a history of Lyme disease, see Long COVID and Lyme disease: what patients need to know.
Can someone have both Lyme disease and Long COVID?
Yes. A person with previous or current Lyme disease can also develop Long COVID after a SARS-CoV-2 infection. COVID-19 may also worsen symptoms associated with a preexisting illness.
A published case report described a young woman with a history of Lyme disease who developed persistent symptoms following COVID-19. The report illustrates how overlapping illnesses can complicate diagnosis, but a single case cannot establish how often this occurs or determine the explanation for every patient’s symptoms.
Clinicians should avoid assuming that one diagnosis automatically excludes the other.
When should clinicians reconsider the diagnosis?
Reconsideration may be appropriate when:
- Symptoms began before the suspected COVID-19 infection
- There is no clear history of a preceding SARS-CoV-2 infection
- The illness does not fit the expected post-COVID pattern
- New objective neurologic, cardiac, or joint findings develop
- Migratory pain, an expanding rash, facial weakness, or radicular pain occurs
- Exposure history raises concern for a tick-borne illness
- Laboratory abnormalities suggest another infection or medical condition
- New findings emerge that are not adequately explained by the existing diagnosis
None of these findings proves that a patient has Lyme disease. They indicate that the differential diagnosis may need to be expanded.
Frequently Asked Questions
Can Lyme disease be misdiagnosed as Long COVID?
Yes. Lyme disease and Long COVID share symptoms including fatigue, brain fog, dizziness, pain, exercise intolerance, autonomic symptoms, and sleep problems. Misdiagnosis is possible, but the frequency with which it occurs has not been established.
What symptoms overlap between Lyme disease and Long COVID?
Overlapping symptoms may include fatigue, cognitive dysfunction, headaches, dizziness, sleep disruption, pain, palpitations, autonomic dysfunction, and exercise intolerance. These symptoms are not specific to either condition.
How is Lyme disease different from Long COVID?
Long COVID develops after SARS-CoV-2 infection. Lyme disease results from infection with Borrelia burgdorferi or a related Lyme disease bacterium transmitted through the bite of an infected tick. Exposure history, illness timing, objective clinical findings, and appropriate testing can help distinguish them.
Can a patient have both Lyme disease and Long COVID?
Yes. A patient with Lyme disease can also develop Long COVID following SARS-CoV-2 infection. One diagnosis does not automatically exclude the other.
Should persistent symptoms always be assumed to be Long COVID?
No. Persistent symptoms deserve careful evaluation because Lyme disease, other infections, autonomic disorders, endocrine conditions, anemia, sleep disorders, medication effects, and other medical problems may resemble or coexist with Long COVID.
How often is Lyme disease misdiagnosed?
Lyme disease can be missed or diagnosed late, particularly when the characteristic rash is absent or unnoticed, exposure is not recognized, testing is performed too early, or symptoms resemble another condition. However, research has not established how often Lyme disease is specifically misdiagnosed as Long COVID.
Clinical Takeaway
Long COVID and Lyme disease can both involve fatigue, brain fog, pain, dizziness, autonomic symptoms, sleep disruption, and exercise intolerance. These similarities can complicate diagnosis, but they do not make the conditions interchangeable.
When symptoms predate COVID-19, do not follow a clear SARS-CoV-2 infection, fluctuate unexpectedly, or include findings suggestive of a tick-borne illness, clinicians should reconsider the differential diagnosis. Lyme disease and Long COVID can also coexist.
Related Articles
Similarities of Long COVID and Lyme disease in children
Case study: Lyme disease in a patient with Long COVID
Brain fog and Lyme disease
Lyme disease misdiagnosis
This article is for informational purposes only and is not a substitute for individualized medical evaluation, diagnosis, or treatment.
References
- Centers for Disease Control and Prevention. Long COVID basics. Updated May 6, 2026.
- Centers for Disease Control and Prevention. Long COVID signs and symptoms. Updated March 9, 2026.
- Patterson BK, Guevara-Coto J, Mora J, et al. Long COVID diagnostic with differentiation from chronic Lyme disease using machine learning and cytokine hubs. Scientific Reports. 2024;14:19743.
- Thor DC, Suarez S. Corona with Lyme: A Long COVID case study. Cureus. 2023;15(3):e36624.
- Aucott JN, Rebman AW. Long-haul COVID: Heed the lessons from other infection-triggered illnesses. The Lancet. 2021;397(10278):967–968.
- Cameron DJ, McWhinney SR. Consequences of contracting COVID-19 or taking the COVID-19 vaccine for individuals with a history of Lyme disease. Antibiotics. 2023;12(3):493.
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
