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A 43-year-old woman initially presented to an oncology clinic with symptoms of lymphadenopathy, a disease of the lymph nodes. She complained of low-grade fever, generalized swelling of lymph nodes, migrating aches in joints of arms and legs, dryness in mouth and eyes, weight loss, and fatigue for the past 6 months, writes Smiyan and colleagues. [1] But clinicians were able to rule out lymphoma.
The patient, who also exhibited clinical signs of Sjögren’s syndrome, an autoimmune disorder which impacts the glands that make tears and saliva, causing dry mouth and dry eyes, was then referred to a rheumatology clinic for evaluation.
The woman met the criteria for Sjögren’s syndrome based on the following findings:
- Keratoconjunctivitis sicca (dryness of the conjunctiva and cornea);
- Xerostomia (a dry mouth resulting from reduced or absent saliva flow);
- Positive tests for antinuclear antibodies, anti-Ro (SSA), anti-La (SSB), anti-SS-A, and anti-SS-B IgG antibodies;
- Negative tests for double-stranded DNA antibodies, anti-ribosomal P protein antibodies, anticentromere antibodies, Sm, Sm/RNP, RNP, Scl-70, and Jo-1 antibodies.
After discovering the patient had a tick bite a year earlier, Lyme disease tests were ordered. Results were positive by enzyme immunoassay and IgM and IgG Western blot analysis.
[bctt tweet=”Lyme disease mimics autoimmune disorder, Sjogren’s syndrome. ” username=”DrDanielCameron”]
“On the basis of the above findings, the patient was also diagnosed with Lyme borreliosis associated with Sjögren’s syndrome,” writes Smiyan. “This lymph node hyperplasia was initially erroneously presumed to be a manifestation of a malignant lymphoma.”
The woman improved with 30 days of doxycycline. “The body temperature normalized, and oral and ocular sicca symptoms decreased,” writes Smiyan. Furthermore, her “swollen cervical lymph nodes returned to normal, and the size of axillary lymph nodes significantly decreased.”
“Lyme borreliosis manifesting as Sjögren’s syndrome and lymphadenopathy was confirmed by the performed laboratory studies and by the positive effect of antibacterial therapy,” the authors conclude.
Related Articles:
Can Lyme disease trigger an autoimmune disease?
Could Lyme disease be another infection associated with the onset of Guillain-Barre syndrome?
References:
- Smiyan S, Galaychuk I, Zhulkevych I, et al. Sjogren’s syndrome and lymphadenopathy unraveling the diagnosis of Lyme disease. Reumatologia. 2019;57(1):59-62.
- Novitch M, Wahab A, Kakarala R, Mukerji R. The Emergence of a Forgotten Entity: Dermatomyositis-like Presentation of Lyme Disease in Rural Wisconsin. Cureus. 2018;10(5):e2608.
- Patel K, Shah S, Subedi D. Clinical association: Lyme disease and Guillain-Barre syndrome. Am J Emerg Med. 2017.
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Hello they diagnosed me whit primary Sjögren. For a second opinion, because of the neurological problems, I’ve been now in a universitair science hospital whit a professor in autoimmuune diseases. She think that I haven”t, but all of the antibodies, SSA/SSb and ANA are positive. I get a biopy later, but when this is negative I have nothing and they ignore Lyme. By the way, I get sick after a tick 21 years ago and my LTT test is positive.
Lyme Disease manifesting as Sjogren’s? Positive Sjorgen’s tests? Positive after Lyme treatment or negative? I have Lyme Disease with all the symptoms of Sjogren’s. I test negative for SS – ANA and all things related to auto-immune. Have not done lip biopsy. LD can cause dryness issues. Please clarify above statements written by the doctor. Thank you.
I had the same questions. A case report and discussion can raise the questions that can lead to more research.
I’ve never been treated for Lyme. I had in 1998 a tick, in 1999 meningo-encefalitis and 8 years later [2006] GBS. In Holland they give only a Elisatest and when this is negative, you don’t give a Westernblot. In 2006 I send my serum to Germany and I had only p41 and kda20 in Igg, this was 2 months before the GBS [Guillian Baree syndroom/ AMAN variant}. I was paralised and also terrible breathing. I tested again after 6 weeks, the results came back, p41 positive , kda20 was gone and there was the kda39, both only in Igg. In 2016 I tested different antiglioside, the Gd1a was still 10 percent more then the others. The Gd1a alone, is most relavant for the AMAN variant in GBS.
There is growing interest in revisiting the diagnoses you discussed. There are also a growing numbers of laboratory tests that have been introduced. Your post reflects the challenges.
What could I have? I have celiac. Went gluten free over a year now after that diagnosis at 38, including a scope. Pretty High ANA. All other test are negative. No other autoimmune issue that the rheumatologist could diagnose. Checked everything they could with liver and kidneys etc. no rheumatoid factor. I have joint and muscle pain, fatigue, brain fog, the dry eyes that cause blurry vision. I do get tingling and twitches. I had low vitamin D, and take supplements. Had several embedded ticks as a youth in VA. So I had a doc check for Lyme. The western blot test a year ago was considered negative. It says IgG P41 present though. Does this rule out all tick diseases? Rheumatologist thinks I could have an uncategorized autoimmune issue.
I am sorry to hear you are ill. I am glad you had a thorough evaluation. A positive IgG 41 band is common even in healthy patients. Some patients have Lyme disease with a negative test. I encourage individuals with unexplained symptoms after an exhaustive evaluation to consult a doctor experienced in treating Lyme disease. Call my office at 914 666 4665 if you have any questions.
In the case study you noted above, the woman had positive antibodies for Sjogrens but her symptoms improved with antibiotics for the Lyme. Did her Sjogrens antibodies also go negative after treatment? I have tested negative for all autoimmune blood tests except one borderline positive on the early Sjogrens panel (SP-1 IGM only). Could this be from my Lyme or could it be true Sjogrens?
The case report focused on the Lyme disease.
I did not know that I had Lyme disease till age 54, not treated 3 specified species incl. BB aquired in Europe, one mystery unspecified type I share with my daughter born in United States, she does not have 3 types from my childhood. I had horrible pain for years, neurologists did not find any cause, I was tested last year and treated. While on treatment, I felt great. I did have even before treatment symptoms of Pancreatic insufficiency, there was undigested food in my stools, finally I was diagnosed. My eye doctor thinks that I have an autoimmune disease, but tests did not show it. Eye doctor prescribed steroid drops when I had blurry vision and really dry eyes and bloody veins, this keeps coming back. I feel inflammation and sweating when I am not treated, especially at night my abdomen feels inflamed in spite of being on enzymes three times a day. I still have some undigested food in my stools and now yellow urine in the morning. I hope that the doctors will figure out what can be done. I always felt better when being treated, but my symptoms keep coming back. I hope that my now year long journey including experiencing palpitations and high blood pressure which went down when I was on doxycycline and later combination therapy will end up successfully, at first nobody wanted to believe that there was anything wrong with me, but the pancreatic insufficiency test showed that it is severe.
I think this might be linked to antibodeis adrenergic and muscarinic receptors, as you know muscarinic receptor antibodies are found in Sjogrens (to M3 receptor), but also in ASIA syndrome, silicone induced autoimmune disease that’s practically the same as Sjogrens but with the known cause. Same Muscarinic and adrenergic receptors are crucial in POTS and other dysautonomias, which are as we know very freuquent in Lyme. In other words, there should be a study if Lyme can trigger muscarinic antibodies. As I’ve heard on researcher, dr Alan Light, suspects those antibodies are triggered by strep, which is again often POTS+PANDAS, but I don’t see a pattern in POTS with relapses from strep throat like in PANDAS. there is connection to EBV, and there is case reports on POTS from Lyme. I personally stopped believing in ILADS view on chronic Lyme after years of very unsuccessful treaetment that only exacerbated my hidden autoimmunities with all the herxing. Since then, I just see tons of neuro-Sjogrens, neuro-Lupus, neuro-behcet, dysautonomias, in that Lyme world, people showing up on various autoimmune labs as positive but nothing specific….. for me, seems it’s just autoimmune disease, sometimes there is Lyme as factor, other times not. Clinical diagnosis of Lyme makes no sense because the symptoms overlap with all the mentioned autoimmune diseases….. What do you think dr.Cameron about my views? Not to go into SIBO and if all the ‘herxing’ is gut shifting.
We are far from understanding the immune response to tick borne pathogens. The cytokine storm in COVID-19 reminds us of how little we know.
Dear Dr. Cameron, We all appreciate so much that you reach out with your lyme conversations and case reports.
Most of the articles I read apply to patients who did not know they had a tick bite.
What about a situation where you know you were bit by a tick and it was on for days when found. Treated with three weeks Doxy low dose 100 mg twice daily. New symptoms came WHILE on Doxy and continued….. Such as on and off low grade fevers , Weight loss, Slightly flu like four times in six months, fleeting mild nausea? Lasted 6 months and predominantly fleeting and mild.
The only symptom that stayed was nerve related cold patches and burning skin which I know to be very likely small fiber neuropathy. I just saw a Neuromuscular doctor for cold patches and burning patches on limbs and arms,
tops and bottoms of feet
He ended up ordering the anti-nuclear antibody test
Normal is less than 80 at his lab and my level was 1280. I’m wondering if you think time will correct this high level. The symptoms Normal is less than 80 at his lab and mine was 1280. The symptoms actually started Improving days after I saw him. Would you be very concerned about this tighter being so high? I worry about the possibility of auto immune disease being triggered, it would be interesting to know how an ILADS physician would choose to treat this inflammation. Considering how the spirochete changes forms: Round bodies and cysts, and can again become active motile … Do they change forms only if antibiotics are used? Is it important to treat the inflammation since no auto immune diseases were found by testing, but I know bacterial infections can lead to inflammation. What about the patient who was already treated two weeks after the bite but continued with symptoms. Is it only a matter of time with fingers crossed that no auto immune disease will surface because of this substantial inflammation?
WHAT APPROACH WOULD YOU CHOOSE ABOUT THIS INFLAMMATION? You write a lot of articles about the nervous system in general, more than I can find anywhere .
Thanks Dr Cameron!
The ANA is often elevated in patients who do not have Lupus. I treat my patients rather than the ANA. I also send my patients to a rheumatologist to allow them to weigh in. I don’t think we understand what goes on in the body to answer the remaining questions. And then there is the question whether there is a persistent tick borne infection.
PLEASE HELP.dx’d Lyme initially 2003. Treated with iv doxy approx 1 1/2 yrs. Totally recovered. Relapsed 2011. Treated again with numerous iv antibiotics for approx 9 mos. Did not seem to be improving. Weight down to 85 #s. Stopped antibiotics 2016. Dealing with terrible nerve pain. In 2016, Pain Mgmnt dr put me on 10 mgs methadone and 1mg lorazepam 3 X day. When pain under control, began to function again. Started working 2018. Began reducing medication dosage by 2020 taking only 5 mgs methadone and 1/2 mg lorazepam 1X day.
Beginning May/June 2020 started burning tongue felt raw. Continued to progress to horrible burning lips, teeth hurting. By August, noticed some muscle weakness, brain fog, terrible itchy skin on arms. Scratching til bleeds. Dry mouth and dry nasal passages,, dark, viscous vaginal discharge, hair loss. Still working. Saw pcp in September, had read sjogrens symptoms could associated with Lyme. Ask if he would allow 30 day regimen of doxy 100 mgs 2 x day. Delayed start due to work, but mouth hurting so terribly started antibiotics first part October. Three weeks in, symptoms had progressed to no longer being able to work. Difficulty walking due to muscle weakness, lips stopped burning, but mouth so dry can’t sleep. Have to drink all night. No longer functioning due to muscle weakness, neuropathy, numbness, saw Lyme 12/23/20. asked about sjogrens. He just asked if I had been tested. Didn’t order tests for sjogrens. Saw local NP on 12/30/20. She ordered comp metabolic panel egfr, c reactive protein, sed rate erythrocyte, rheumatoid factor. I’m no dr but all look normal. Please help me. Is is ok to continue to take 5 mgs methadone and 1/2 mg lorazepam for pain. PLEASE ADVISE about pain meds and next step to take. Desperate. Thank you.
I have had difficulties managing pain if antibiotics are not effective. I have had to refer these patients to pain management and they also have had difficulties managing the pain.
Rebecca. I’m absolutely not a doctor. But time for antibiotics is probably over. Have you ever try prednisone or dexamethazone for inflammation and hydroxychloroquine for cytokine storm? Your Lyme has become chronic autoimmune
I have patients in my practice who find it difficult to put aside antibiotics if they had earlier gains. I use a number of specialists to look for other causes and treatments. I have some patients who have had to use lower dose prednisone.
I was diagnosed with Lyme disease last fall. IGg was positive and IGm was negative, showing a past infection of Lyme. I never had any of the typical symptoms of Lyme disease. I was treated with 3 weeks of doxycycline. Around the same time I started having dry eyes. Currently being treated for that condition. Vision is quite blurry. Are the dry eyes from Lyme disease?
The IgG test can become positive within six weeks. I do not recommend the term “old Lyme disease”. An IgG can remain positive even in someone with a persistent infection. I have had to rely on clinical judgment. I have encouraged my patients to include an evaluation for a tick borne illness if there are unexplained dry eyes and blurry vision.
Greetings..I’ve have a positive Ssb but my symptoms are consistent with Lyme Disease. I have not responded to Sjogren’s treatment. Any thoughts?
“A positive result for SS-B/La antibodies is consistent with connective tissue disease, including Sjogren syndrome and lupus erythematosus.” per https://www.mayocliniclabs.com/test-catalog/overview/81359 It may not be Sjogren’s syndrome I have had patients in my practice with both conditions.
Hello, I have a few questions centering around Morgellons. I would be most grateful for your response.
Have you completed any studies on possible links to Morgellons?
Have you seen Lyme patients presenting with Morgellons chronic lesions and fibers?
There are those who believe Lyme is Morgellons and this is disturbing as well as confusing to those not having contact with Lyme parasites such as ticks and fleas. Also, there are many Morgellons victims that have negative Lyme tests, some more than one neg test.
My Morgellons symptoms are not what I’ve read Lyme symptoms are.
I would appreciate your comments. Thanks
I have not conducted any independent research. I have seen Lyme disease patients who fit the Morgellons case definition. They are understandably frustrated by the time I see them. The experts in Morgellon have found antibiotics helpful in some cases. The experts have not found other treatment all that successful. I have had some success with antibiotics for patients who are willing. Their symptoms are quite varied. I also have them see other doctors to rule out other illnesses.
Had dry cotton mouth that no amount of drinking water will help since December 19. Comes and goes. Have neurological lyme and a few confections. Bedridden most days. On SOT Therapy. Had sudden swollen saliva glands u see tongue for about a decade as well as bad diarrhea. Never thought much of the former. Removed 4 stones on Saturday night from saliva gland two days ago. Found out about sjorgens. How do I get tested for it in SA? What tests does one do. What is treatment? Thank you /(Please excuse writing. My cognitive function currently compromised).
I typically advised my patients to work closely with a rheumatologist for further tests and for a discussion of treatment options. I also advise my patients to work with a doctor experienced in treating Lyme disease and co-infection at the same time. Some of my patients have more than one condition.
My PTLDS has manifested itself in mimicking Multiple Sclerosis – chills, sweats, and fatigue. This has been going on for 3 years.
Sometimes they go into remission. Do you have any advice or treatment? I study the Johns Hopkins, Columbia Medical, and other PTLDS Centers but I guess nobody has a solution to the autoimmune inflammation.
I have have a few Lyme disease patients in my practice who have mimicked autoimmune issues including multiple sclerosis who have responded to antibiotics. Some have not.
I spent 4 years in treatment for Borellia B, Bartonella, and Babesia Duncani. For five years I was on no medication, doctors all ignoring my symptoms including profound fatigue, daily headaches, sore soles of feet in AM, dizziness, some sweating and air hunger. I traveled to see a LLNP in 2019. I tested positive for Bb but not Bartonella or Babesia. I went back on antibiotics for Bartonella and Babesia, with a lot of trouble tolerating the drugs. In early 2020, Minocycline caused a huge flare of pain, after which my blood work was very high for Rheumatoid arthritis. Plaquenil helped calm the inflammation in my feet and hands, but about two months ago, I was diagnosed with Sjorgren’s (in addition to the RA). Could this all be Lyme related or one of the other infections? Thank You.
I have Lyme disease patients who have tested positive for various rheumatologic disorders. I advise them to remain under the care of a rheumatologist. I take the approach that some individuals have a tick borne illness concurrent with their rheumatologic condition. I have found antibiotics helpful for these individuals. I thought the article referred to in the blog should lead to a discussion of a potential cause of a rheumatologic condition.
I had dermatomyositis in 1977, at age 10. After 6 months of prednisone, I’ve been in remission ever since. In July 2020 I was diagnosed with Lyme disease. When the test results came back the doctor said I had also “had it sometime in the past.” After reading this article, I wonder if I had it in 1977.
In 2012 camping I was bitten by several ticks. I began manifesting inflammation, fatigue, brain fog, etc. Have been tested for Lyme in the last couple of years (western blot) but comes up negative. ANA shows positive. Doing research my symptoms don’t align with autoimmune disorders yet I have taken the online Horowitz Lyme questionnaire and score 79 out of 45 for probable tick borne illness. I understand late Lyme can show false negative in blood testing. I’m at a loss on how to proceed with getting a diagnosis and absolutely rule out Lyme. My rheumatoid factors are also negative. I fear being placed on immunosuppressants when my symptoms just don’t align with an autoimmune disorder. Any guidance would be appreciated.
I advise my patients with multiple medical problems despite a comprehensive evaluation to include a doctor who has experience treating chronic manifestations of Lyme disease.
I advise my patients with multiple medical problems despite a comprehensive evaluation include a doctor who has experience treating chronic manifestations of Lyme disease.
I tested positive for Lyme disease in 2003 while visiting family in WV, when I noticed a strange red rash on my torso. At the time, I had been living in Connecticut since 1983, and as you probably know, Lyme disease was discovered in Lyme, CT so I was sure the rash was caused by the Lyme tick, got tested ASAP and sure enough the Lyme titer was positive. I was put on the standard antibiotic treatment and as far as I know, I was “cured.” But now, all these years later, I have chronic pain which is ruining my life! I have terrible low back pain and sciatic pain and hip pain. Now using a cane, and have to rest a LOT! I have unbelievable dry mouth which sometimes isn’t dry, but is like way too much salivating. I take OTC pain meds which take the edge off but I’m in pain every single day! I had X-rays done for lumbar pain which showed degenerative disk disease, the pain gradually became worse and now here I am. Before I became chronic, though, with this pain, I did have some mild anxiety and depression symptoms, which were exacerbated by a diagnosis of serious mental illness in my son (schizophrenia) in 2013. This has caused depression that is not helped by antidepressants. I understand the connection (sort of) between physical pain and depression/anxiety and that they can feed off each other. But I’ve recently been looking into the Lyme again and wondering if I might actually still have Lyme?? Im confused and in pain. My son’s condition started my descent into more than just regular depression. Then my pain just soared as well and now I have no idea what’s wrong with me! Chronic pain? Lyme? Autoimmune? Can you please help me by steering me towards what I don’t know. My doctor is great but she just wants to treat my depression.
I am glad you have a great doctor. I have doctors in my area that are great doctors but are reluctant to consider a tick borne illness. I recommend that patients in my practice include an evaluation for Lyme disease. I also consider reinfection from another tick. Finally, I have Lyme disease patients in my practice who are not aware they have Lyme disease until they experience stress.
Bonjour , j’ ai 40 ans , cela fait plus de 20 ans que je suis en errance medical , les symptômes ont commencé quand j’avais 16 ans , on m’a diagnostiquée Lyme stade 3 , j’avais 30 ans , j’étais dans un état épouvantable ( douleur articulaire épouvantable , fatigue chronique , frilosité constante …) .
J’ai suivi 4 ans de traitement de Lyme ( antibiothérapie , perfusion , ….) et aucune amélioration .
Vers 36 ans , il y a 4 ans , de nouveaux symptômes se sont annoncés : bouche et langue brûlante , bouche sèche , yeux secs , nez sec , oreilles sèches , peau sèche , sécheresse vaginale , ….. l’enfer …. En plus des douleurs articulaires .
On m’a diagnostiqué un syndrome de gougerot . Le mois dernier j’étais à l’hôpital pour une biopsie des glandes salivaires. J’attends les résultats pour cette maladie . Je souffre énormément et je suis passée à côté de ma vie et je vis de manière isolé car aucun médecin ne me croit .
Je suis désemparée et fatiguée de me battre .
From Google translation
Hello, I am 40 years old, I have been in medical wandering for more than 20 years, the symptoms started when I was 16, I was diagnosed Lyme stage 3, I was 30, I was in a terrible state (terrible joint pain, chronic fatigue, constant chilliness…).
I followed 4 years of Lyme treatment (antibiotic therapy, infusion, etc.) and no improvement.
Around 36, 4 years ago, new symptoms appeared: burning mouth and tongue, dry mouth, dry eyes, dry nose, dry ears, dry skin, vaginal dryness, ….. hell …. In addition to joint pain.
I was diagnosed with gougerot [Sjögren’s syndrome] syndrome. Last month I was in the hospital for a salivary gland biopsy. I am awaiting the results for this disease. I suffer a lot and I missed out on my life and I live in isolation because no doctor believes me.
I am distraught and tired of fighting.
I have had Lyme for over 40 years. I tested positive in the São Paulo Lyme lab in CA. in 2006. The Dr. who diagnosed me was in Utah where I went at my daughters request due to my several health issues which were mounting yearly. I am now 79 and have acquired Parkinson’s and a serious case of Sjogrens and now have it in my heart. I have visited ER about 5 times due to chest pain where they usually tell me it is due to anxiety. My provider finally had an unusual CKG and referred me to a Cardiologist . I do not have much hope of getting actual help. Every Doctor I have gone to here in my home town changed the subject when I mention I have Lyme.
I advise my patients to include a doctor familiar with Lyme disease in addition to their other doctors.
That’s easier said than done. No llmd’s in the south, Ga in my case, and ID docs don’t admit to knowing much. Plus, insurance doesn’t cover it so most folks have no options. I was sick with many symptoms for 2 yrs before dx. Was CDC positive. Did manage to get 6 weeks of IV rocephin, which helped the neuro symptoms at the time but have continued to have many increasing issues since. I’m 74 now and had Lyme for 12yrs. Sadly, seems like there’s no help or choice for me. I now have anti phospholipid syndrome, low CK clearance and other blood issues. Any suggestions?
I find it difficult to determine if one of my patients has a persistent tick-borne infection. I have had my patients consult other doctors to sure another illness is not playing a role. I hope you can find a doctor who has experience working with Lyme disease.
Hello Doctor Cameron, I just found your podcast. I was diagnosed Lyme in October 2021 and I was under treatment for 2 week. In January 2022 I started losing a lot of hair, my vision was blurry and my eyes dry. In July 2022 I tested positive for antibodies RNP and Ro60. I am taking plaquenil since then, but my symptoms are not improving and now I am feeling pain in my knees. Also, just to check, the doctor ordered Lyme test and I tested negative (apparently all sign of Lyme disappeared from my blood). Do you think I could benefit from seeing a lyme disease doctor ? I would much appreciate your opinion. Thank you
I have patients in my practice who remain ill with Lyme disease despite 2 week of treatment. The antibiotic treatment can interfere with tests. I also have patients with Lyme disease and an underlying rheumatologic condition. I typically advise my patient to continue to work with there rheumatologist while working with a doctor experienced in treating Lyme disease.
I have had a positive Western Blot test and am currently reviewing the treatment regime recommended by my doctor, I have most of the symptoms associated with Lymes but I also have Peyroins Disease, have you seen this before as a symptom of Lymes?
I believe you are talking about peyronie’s disease [Fibrous scar tissue inside the penis that causes curved, painful erections] I have not
Lyme doesnt mimics. Lyme and other TBIs are the CAUSE of autoimmunity, incl Sjogren. My saliva disappeared with Lyme and it slowly coming back now, 4 yrs into Lyme hell. Dry eyes, dry mucosa, dry skin… Lyme, Bartonella, Erlichia and other TBIs are behind it.