Dr. Daniel Cameron: Inside Lyme Podcast

Lyme Podcast: Sjögren’s syndrome secondary to Lyme disease

A 43-year-old woman with Sjögren’s syndrome secondary to Lyme disease.

I will discuss a 43-year-old woman with Sjögren’s syndrome secondary to Lyme disease in this Inside Lyme podcast. Her 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.

Several doctors saw her. The oncologist focused on the generalized swelling of her lymph nodes. The oncologist initially thought she had Lymphoma. Even the biopsy suggested Lymphoma.

Her saliva flow was significantly reduced. The dentist concluded she suffered from xerostomia. Xerostomia is a dry mouth resulting from reduced or absent saliva flow.

Her eyes were dry. The ophthalmologist concluded she suffered from keratoconjunctivitis sicca. 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 concluded that she 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.

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 is a growing number of autoimmune illnesses in addition to Sjögren’s syndrome, where the body’s 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, she suffered from secondary Sjögren’s syndrome since the onset of Sjögren’s syndrome was after a tick bite, and the symptoms improved with antibiotic treatment. In this case, Lyme disease mimicked primary Sjögren’s syndrome.

What can we learn from this cases?

  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. This woman’s Secondary Sjögren’s syndrome due to Lyme disease improved with antibiotics.

What questions does these cases 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?

Treating Tick-Borne Disease In My Practice

In my practice, each individual requires a careful assessment. That is why I order a broad range of blood tests for other illnesses in addition to tick-borne infections. I also arrange consultations with specialists as needed.

Many patients are complex, as highlighted in this Inside Lyme Podcast series.

We need more doctors with skills recognizing a tick-borne illness in an individual with Sjögren’s syndrome. We hope that if professionals evaluating individuals with Sjögren’s syndrome can use this case to remind them to look for tick-borne illnesses and treat accordingly.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook 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.

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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.
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