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.

References:
  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"

  • Jean
    12/17/2021 (4:33 am)
    Reply

    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.

    • Dr. Daniel Cameron
      12/17/2021 (12:45 pm)
      Reply

      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.

  • Elizabeth Ingham
    10/15/2021 (10:13 am)
    Reply

    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.

    • Dr. Daniel Cameron
      10/17/2021 (11:41 pm)
      Reply

      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.

    • Dr. Daniel Cameron
      10/18/2021 (1:40 pm)
      Reply

      I advise my patients with multiple medical problems despite a comprehensive evaluation include a doctor who has experience treating chronic manifestations of Lyme disease.

  • TracyBishop
    09/20/2021 (8:48 am)
    Reply

    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.

  • Bev Hennager
    06/21/2021 (9:37 pm)
    Reply

    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.

    • Dr. Daniel Cameron
      06/22/2021 (8:32 am)
      Reply

      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. 

  • Mark Zinan
    05/16/2021 (6:18 pm)
    Reply

    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.

    • Dr. Daniel Cameron
      05/16/2021 (11:21 pm)
      Reply

      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.

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