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"

  • Don
    09/18/2022 (9:12 am)
    Reply

    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?

    • Dr. Daniel Cameron
      09/19/2022 (11:02 am)
      Reply

      I believe you are talking about peyronie’s disease [Fibrous scar tissue inside the penis that causes curved, painful erections] I have not

  • Linda Walley
    07/18/2022 (8:16 pm)
    Reply

    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.

    • Dr. Daniel Cameron
      07/20/2022 (9:12 am)
      Reply

      I advise my patients to include a doctor familiar with Lyme disease in addition to their other doctors.

      • Jerrie Whitfield
        11/11/2022 (1:27 pm)
        Reply

        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?

        • Dr. Daniel Cameron
          11/11/2022 (4:49 pm)
          Reply

          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.

      • Natalia
        12/07/2022 (1:59 am)
        Reply

        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

        • Dr. Daniel Cameron
          12/07/2022 (6:14 pm)
          Reply

          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.

    • Dr. Daniel Cameron
      07/21/2022 (7:33 am)
      Reply

      I have urged my colleagues to look a second time at tick borne pathogens in case some of the symptoms are related to a tick borne infection.

  • Chaput Hélène
    04/08/2022 (1:27 pm)
    Reply

    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.

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