Lyme disease manifests as an autoimmune disorder, Sjögren’s syndrome

Lyme disease symptoms can mimic many other illnesses and have been linked to several autoimmune diseases including Sjögren’s syndrome [1], Dermatomyositis [2], and Guillain-Barre syndrome [3]. A case report by Smiyan entitled “Sjögren’s syndrome and lymphadenopathy unraveling the diagnosis of Lyme disease,” reflects the importance of a thorough clinical evaluation.

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.

  1. 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.
  2. 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.
  3. Patel K, Shah S, Subedi D. Clinical association: Lyme disease and Guillain-Barre syndrome. Am J Emerg Med. 2017.

47 Replies to "Lyme disease manifests as an autoimmune disorder, Sjögren’s syndrome"

  • Patty
    05/12/2020 (6:55 pm)

    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.

    • Dr. Daniel Cameron
      05/12/2020 (7:03 pm)

      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.

  • Mirka
    03/04/2020 (12:02 pm)

    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.

  • Lyme and Sjogren
    05/10/2019 (12:01 am)

    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.

    • Dr. Daniel Cameron
      05/10/2019 (11:28 am)

      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.

      • Teresa Stromberg
        06/17/2020 (9:04 pm)

        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.

        • Dr. Daniel Cameron
          06/18/2020 (9:44 am)

          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.

      • Kimberly
        06/08/2021 (10:00 am)

        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?

  • Susan Vaughan
    05/09/2019 (5:58 am)

    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.

    • Dr. Daniel Cameron
      05/09/2019 (11:35 am)

      I had the same questions. A case report and discussion can raise the questions that can lead to more research.

  • Lyme and Sjögren
    03/29/2019 (9:51 pm)

    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.

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