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.


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.

A woman’s diagnosis was changed from possible Lymphoma to primary Sjögren’s syndrome to secondary Sjögren’s syndrome. Click To Tweet

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?

  1. 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.
  2. 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.
  3. Lyme disease can mimic Sjögren’s syndrome.
  4. In this case, the patient’s secondary Sjögren’s syndrome due to Lyme disease improved with antibiotics.

What questions does this case raise?

  1. How often does Lyme disease mimic a Lymphoma or an autoimmune illness?
  2. 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

This Inside Lyme case series will be discussed on my Facebook page and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

  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.

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David Poteet
David Poteet
1 month ago

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.

Abigail Bisson
Abigail Bisson
30 days ago
Reply to  David Poteet

Have you checked into SOT therapy for your Lyme? I am having patients report good responses to this novel therapy.
Dr B

Elizabeth Wells
Elizabeth Wells
3 months ago

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.

Elizabeth Wells
Elizabeth Wells
1 month ago

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.

Joanna cristini
Joanna cristini
1 year ago

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.