Can Lyme Disease Be Misdiagnosed as Long COVID?
Lyme disease may be misdiagnosed as Long COVID
Both illnesses share overlapping symptoms
The right diagnosis changes treatment options
Since the pandemic, I’ve seen more patients labeled with Long COVID—only to discover later they were dealing with something else.
Lyme misdiagnosed as Long COVID has become an increasingly important clinical question because both conditions share symptoms that can persist for months or years.
My patient was told her fatigue, brain fog, dizziness, and poor sleep were just viral aftereffects. Some reassured her it would fade. Others told her it was untreatable. But she wasn’t getting better.
When I took a closer look?
It wasn’t Long COVID.
She was suffering from Lyme disease symptoms that had been misdiagnosed as Long COVID.
That distinction changes everything—from treatment decisions to long-term outcomes.
Why Lyme disease can be mistaken for Long COVID
It’s easy to understand why confusion occurs. Both Lyme disease and Long COVID can cause overlapping symptoms that affect cognition, energy, autonomic function, and quality of life.
The overlap can be striking because both illnesses affect multiple body systems and may produce fluctuating symptoms.
- Brain fog and slowed processing
- Chronic fatigue
- POTS, dizziness, or lightheadedness
- Mood changes
- Migratory pain
- Exercise intolerance
- Poor sleep
Both conditions may also involve autonomic dysfunction, which is why symptoms such as dizziness and rapid heart rate can overlap with autonomic dysfunction in Lyme disease.
But while Long COVID care often focuses on symptom management, Lyme disease and tick-borne coinfections may require a different diagnostic and treatment approach.
I’ve had patients who never had COVID—or recovered fully—then became ill months later. The trigger was not always viral. Sometimes it was an undiagnosed tick-borne illness.
The risks of mislabeling persistent symptoms
Long COVID has helped validate persistent symptoms. But labels can sometimes narrow diagnostic thinking too early.
When physicians assume all fatigue and brain fog are viral in origin, important questions may never get asked.
- Was Lyme disease truly ruled out?
- Were coinfections such as Bartonella or Babesia considered?
- Were tests interpreted clinically rather than dismissed when negative?
I’ve had patients remain under the Long COVID umbrella for more than a year without improvement—until we identified and treated the infection beneath it all.
How I evaluate possible Lyme disease misdiagnosed as Long COVID
When symptoms persist or do not fit typical recovery patterns, I broaden the differential diagnosis.
- Review outdoor exposure, travel, and prior illnesses
- Evaluate Lyme testing limitations and testing quality carefully
- Screen for tick-borne coinfections
- Use clinical judgment alongside laboratory testing
- Reevaluate prior diagnoses when symptoms persist
Once underlying infection is addressed, some patients report improvement in symptoms previously labeled as post-viral.
For a more comprehensive overview of the overlap between both conditions—including my research involving 889 patients—see Long COVID and Lyme disease: what patients need to know.
When should clinicians reconsider the diagnosis?
Certain clues may justify revisiting the diagnosis.
- Symptoms started before COVID infection
- Symptoms continued despite supportive care
- Night sweats, migratory pain, or fluctuating symptoms developed
- Exposure history raises concern for tick-borne illness
These features do not prove Lyme disease—but they may justify additional evaluation.
Frequently Asked Questions
Can Lyme disease be misdiagnosed as Long COVID?
Yes. Both conditions share symptoms including fatigue, brain fog, dizziness, exercise intolerance, and sleep problems, making misdiagnosis possible.
What symptoms overlap between Lyme disease and Long COVID?
Shared symptoms may include fatigue, cognitive dysfunction, dizziness, sleep problems, pain, autonomic dysfunction, and exercise intolerance.
How is Lyme disease different from Long COVID?
Lyme disease may involve tick exposure, coinfections, migratory symptoms, and treatment approaches that differ from post-viral management.
Should persistent symptoms always be assumed to be Long COVID?
No. Persistent symptoms deserve careful evaluation because infection, autonomic dysfunction, and other medical conditions may mimic Long COVID.
How often is Lyme disease misdiagnosed?
Lyme disease may be missed or delayed when symptoms overlap with other conditions, testing is negative early, or clinicians anchor too quickly on another diagnosis.
Clinical Takeaway
Long COVID and Lyme disease share many symptoms, making diagnosis challenging.
When symptoms persist, fluctuate, or fail to improve as expected, clinicians should reconsider the differential diagnosis rather than assume every post-pandemic illness is post-viral.
Related Articles
These articles explore overlap between persistent symptoms, tick-borne illness, and post-infectious recovery.
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
Additional Resources
Long COVID and Lyme disease: what patients need to know
References
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
