Sjögren’s syndrome secondary to Lyme disease

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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.

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.