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.

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

  • Lauren greve
    05/03/2021 (6:12 pm)

    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).

    • Dr. Daniel Cameron
      05/04/2021 (8:13 am)

      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.

  • Nouveau Mucha
    04/12/2021 (8:58 am)

    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

    • Dr. Daniel Cameron
      04/12/2021 (11:18 am)

      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.

  • Lori Matt
    02/12/2021 (7:49 pm)

    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?

    • Dr. Daniel Cameron
      02/13/2021 (8:22 am)

      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.

      • Hayes Hayes
        04/26/2022 (5:18 pm)

        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?

  • Rebecca
    01/01/2021 (1:56 pm)

    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.

    • Dr. Daniel Cameron
      01/02/2021 (9:05 am)

      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.

    • John smith
      04/28/2021 (10:28 pm)

      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

      • Dr. Daniel Cameron
        04/29/2021 (7:03 am)

        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.

  • Jill hontz
    10/13/2020 (1:55 pm)

    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!

    • Dr. Daniel Cameron
      10/13/2020 (7:30 pm)

      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.

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