Dr. Daniel Cameron: Inside Lyme Podcast
Sjögren’s syndrome secondary to Lyme disease
In this Inside Lyme Podcast, I discuss the case of a 43-year-old woman with Sjögren’s syndrome secondary to Lyme disease. The woman’s diagnosis was changed from possible Lymphoma to primary Sjögren’s syndrome to secondary Sjögren’s syndrome.
Smiyan and her colleague first discussed this case in the journal Reumatologia in 2019.
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A 43-year-old woman was ill for six months. She described “complaints of a 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,” wrote the authors.¹
She had consultations with several doctors. The oncologist focused on the generalized swelling of her lymph nodes and initially suspected the patient had Lymphoma. A biopsy supported this.
The woman had a significant reduction in saliva flow, so a dentist concluded she suffered from xerostomia. Xerostomia is a dry mouth resulting from reduced or absent saliva flow.
The patient’s eyes were dry, which lead to the diagnosis of keratoconjunctivitis sicca by an ophthalmologist. Keratoconjunctivitis sicca is the dryness of the conjunctiva and cornea. In Keratoconjunctivitis sicca, there are too few tears, or the tears evaporate too quickly.
The rheumatologist eventually concluded that the woman met the criteria for Sjögren’s syndrome.
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Lyme disease
The rheumatologist also tested for Lyme disease based on her history of a tick bite a year earlier. Her blood tests were positive by an enzyme immunoassay and an IgM and IgG Western blot analysis.
In this case, Lyme disease mimicked primary Sjögren’s syndrome.
The doctors changed their diagnosis from Lymphoma to Lyme disease. “This lymph node hyperplasia was initially erroneously presumed to be a manifestation of a malignant lymphoma,” wrote the authors. The lymph node hyperplasia was a response to Lyme disease.
The woman was prescribed doxycycline for 30 days. Her fever resolved. Her dry eyes and mouth symptoms decreased. Her Lymph nodes improved or were absent.
Secondary Sjögren’s syndrome
The authors also concluded that the patient did not suffer from the primary type of Sjögren’s syndrome. A primary type of Sjögren’s syndrome is a systemic autoimmune disorder.
There are a growing number of autoimmune illnesses in addition to Sjögren’s syndrome, where the immune system mistakenly attacks your body. The list of autoimmune illnesses includes thyroid disease, Lupus, Rheumatoid arthritis, multiple sclerosis, Type I diabetes, chronic inflammatory demyelinating polyneuropathy, and Psoriasis.
Instead, the woman suffered from secondary Sjögren’s syndrome since the onset of her syndrome was after a tick bite, and the symptoms improved with antibiotic treatment.
What can we learn from this Sjögren’s syndrome case?
- It can be helpful to be evaluated by multiple specialists. This 43-year-old woman was evaluated by an oncologist, rheumatologist, dentist, and an ophthalmologist.
- The diagnosis can change as new information becomes available. This woman’s diagnosis was changed from possible Lymphoma to primary Sjögren’s syndrome to secondary Sjögren’s syndrome.
- Lyme disease can mimic Sjögren’s syndrome.
- In this case, the patient’s secondary Sjögren’s syndrome due to Lyme disease improved with antibiotics.
What questions does this case raise?
- How often does Lyme disease mimic a Lymphoma or an autoimmune illness?
- Should individuals with autoimmune illness or Lymphoma be evaluated for Lyme disease?
Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.
Inside Lyme Podcast Series
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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.
Jen Simmons
02/11/2024 (12:39 am)
I started having chest pain in July 23, was misdiagnosed until Sept 23. When my left lung collapsed due to fluid in my chest cavity. They also found many cysts in my right lung. The largest being 6cm. After many test they diagnosed me with Sjogrens. Even thou I didn’t have dry eyes or dry mouth. I felt terrible, migrating joint pain, tired, brain fog, chest pain, head aches, fever. Also my liver is failing. They did a lip biopsy that came back positive. I also had myself test for bacteria. It came back positive for 3 different kinds. I started taking antibiotics in Dec. I am on week 7 of antibiotics and starting to feel better.
Is it possible that I have Sjogrens and a tick bacteria? Or is bacterial infections causing the Sjogrens reaction?
I live in Canada and the whole bacterial infection, tick bite has been very frustrating. There is not a lot of support here for it. Please help.
Dr. Daniel Cameron
02/11/2024 (8:00 am)
I have patients with Lyme disease along with an underlying disease. I also have seen patients who realized they had Lyme disease after gains when they take antibiotics for another condition.
David Poteet
07/28/2023 (3:58 pm)
It took 11 years to be diagnosed with Lyme Disease after being prescribed every anxiety and depression medicine you can think of. After two years of treating Lyme, I was back to about 85%-90%. Then a heart valve replacement surgery opened up my immune system, and I haven’t felt well in 7 years. In this case, I was finally diagnosed with primary Sjogrens Syndrome. It took two years of negative Sjogrens blood tests to finally get a lip biopsy, which was positive. In the case of a positive lip biopsy, I would guess, in my case, it actually is Sjogrens. Neuropathy, dizziness, minor balance issues. Also still test positive for Lyme Disease.
Dr. Daniel Cameron
07/29/2023 (8:20 am)
There is not enough research on Lyme and autoimmune disease to determine if they are related or two common illnesses. It it also difficult to be sure a tick borne infection has resolved.
Abigail Bisson
08/25/2023 (6:18 pm)
Have you checked into SOT therapy for your Lyme? I am having patients report good responses to this novel therapy.
Dr B
Elizabeth Wells
06/02/2023 (3:04 pm)
Sjogren’s or Lyme or both? I am currently 62, white female in Yorktown, VA. In 2016, May, I became extremely ill with neurological symptoms (POTS, brain inflammation, dizziness, flashes of red light when I blinked, vertigo, severe headache, trigeminal neuralgia, glossopharyngeal neuralgia, tachychardia and more). I was diagnosed in the ER with Lyme and that diagnosis was later confirmed by Sabra Bellovin, MD. She also discovered that I had tested positive for Sjogren’s but I didn’t pay any mind to that because I was asymptomatic ( or was I?) and I thought it was just a disease of dry eyes and mouth. No biggie, right? After two years of Lyme treatment with antibiotics and Nutrimedix tinctures, I felt mostly normal but I had developed a strange pain in my inner thigh that prevented me from standing up straight. This pain has continued to get worse. In Feb of 22, the ligaments and tendons around my left knee suddenly ruptured for no reason and I had to live with that completely disabling pain and injury. It’s still injured but I can get around most days. This past winter (2023) I suddenly developed itchy dry eyes, severe dry mouth and the pain in my pelvis/inner thigh is so bad that I can’t sleep at night. I take so much Tylenol and Ibuprofen that I am concerned about my stomach, liver and kidneys. I doubt anyone would prescribe any effective pain medicine because of the opioid crisis, so i don’t bother wasting my money and time consulting with any doctors. I believe that I have some type of connective tissue disorder. My mother has Reynaud’s and arthritis. I’ve never had symptoms of arthritis. Most of my symptoms seem to be neurological. I live in so much pain every day but manage to live a very simple life but I’m exhausted and have no social life. I can’t go anywhere by myself because I can barely walk for any length of time before my leg muscles become severely fatigued, painful and I must stop. I wish so much I could find a doctor that I could trust to help me. No patient should suffer in pain like I do. It’s cruel and inhumane.
Dr. Daniel Cameron
06/03/2023 (2:09 pm)
I have patients with Lyme and a rheumatologic problem. It is hard to know if a positive Sjogren’s test is a true positive even for rheumatologists.
Elizabeth Wells
07/24/2023 (6:54 pm)
I suspected the Sjogren’s test wasn’t reliable ( like the Lyme test). Interestingly enough I’ve had syncope, low blood pressure and low body temperature ( perhaps related to vagus nerve dysfunction) since I was a child. I’ve also had a hundred tick bites in my life. As a teen, when I felt a fainting spell coming on, I would urge my friends to locate salt anywhere they could and place it in my mouth. The salt would snap me right back to normal. When I consulted with my family doctor at that time they told me that I had hypoglycemia. As I matured, the symptoms seemed less frequent, in fact, rare until I got Lyme. I felt as though my entire nervous system was under attack. Nothing worked properly ( poor cognition/dementia, GI motility issues, vision problems, BP and heart rate irregularities) and I’ve had bladder incontinence issues ever since. It’s so frustrating not knowing what is at the root of these symptoms.
Jennifer
01/24/2024 (6:36 pm)
Hi Elizabeth! I have pretty much all of your same symptoms! I was bit as a kid and didn’t realize I had Lyme disease… was bit again at 50 years old and it been a nightmare! All of my issues all these years were due to Lyme and now knowing after being bit a second time been treating the Lyme and it’s not been easy!! I have tested positive also for Sjögren’s disease along with EBV.. having also now every symptom of Lymphoma! It’s been a nightmare to say the least! I am continually going to Dr.’s to figure out if I now have Lymphoma? I feel your pain! It is devastating to wake up everyday feeling like death is at your door! Stay strong and keep fighting! I have been taking Ivermectin, black seed oil, soursop tea and bitter apricot kernels and I am feeling noticeably better!!! My pain is aleviating and my energy and overall wellness is slowly coming back! From my research Lyme disease and cancer go hand in hand! So I started treating my symptoms as if I am dealing with cancer! It is helping tremendously! Can’t hurt to try? Just thought I would share with you what I have been doing.. best of luck! Jennifer
Elizabeth Wells
01/25/2024 (11:32 am)
Thanks Jennifer. Sorry to hear about your struggles. The past two days have been unbearable. Then this morning, I woke with barely any pain and much more energy and I feel ‘normal’ in comparison. This is the unpredictable roller coaster that I live with all the time now. I never know when I’m going to ‘crash’ and the crashes seem to be getting worse. I want to rush as quickly as I can to catch up on my work and chores but I know if I am too enthusiastic, I will become disabled once again for another few days. So frustrating! One thing I’ve noticed is that the moon cycle and barometric pressure changes contribute to my pain and exhaustion. The moon and I have always had a love hate relationship but those full moons really disturb my circadian rhythm and I can’t sleep which leads to more pain!! I’m going to give the blackseed oil another go. I’ve used it a few times but it gives me those pungent burbs and I don’t care for the flavor. I haven’t tried ivermectin but I have used artemisinin with success.
Joanna cristini
03/14/2022 (8:40 am)
Hello My Lyme disease went undiagnosed and untreated for 30+ years. At 48 years old I started seeing a rheumatologist and UHN and after several tests and being part of a study I was diagnosed with UCTD. I have symptoms of lupus, Sjogren’s, Reno syndrome. I have had thyroid cancer, Graves’ disease.