Lyme Disease After Pregnancy: Can Symptoms Appear Postpartum?
Postpartum Lyme symptoms can appear after delivery
Pregnancy-related immune changes may mask symptoms
Lyme disease can occur without a known tick bite
A 23-year-old woman from Brooklyn, New York, presented to her primary care physician with bilateral knee swelling and pain three days after delivering a healthy baby girl. She rated the pain as 8 out of 10 in severity and reported that it worsened with walking.
Case
The patient recalled experiencing similar knee pain for two days during the sixth month of her pregnancy but had not sought medical attention at that time.
During her pregnancy, she had taken several trips to wooded areas in upstate New York, where Lyme disease is endemic. She denied having a known tick bite or noticing an erythema migrans rash.
Testing for Lyme disease revealed a positive Western blot with 9 out of 10 IgG reactive bands, including: 18, 23, 28, 33, 41, 43, 58, 66, and 93 kDa bands.
These results confirmed the diagnosis of Lyme disease, indicating prior exposure to Borrelia burgdorferi, the bacterium responsible for Lyme disease.
The patient was treated successfully with a 3-week course of doxycycline, which resolved her symptoms. Her newborn daughter was symptom-free at birth and continued to remain asymptomatic throughout early childhood and beyond.
Four Key Discussion Points
1. Lyme Disease May Remain Quiet During Pregnancy
This case suggests that Lyme disease can remain asymptomatic or minimally symptomatic during pregnancy. The woman experienced only a brief episode of knee pain during pregnancy, which resolved spontaneously and did not prompt further evaluation.
Her symptoms reappeared abruptly in the postpartum period, possibly due to immunological and hormonal changes associated with childbirth.
Pregnancy alters immune regulation in complex ways. Some clinicians believe these shifts may temporarily suppress inflammatory symptoms in certain patients, only for symptoms to emerge again after delivery.
2. No Evidence of Congenital Lyme Disease in This Case
The authors reported no evidence of congenital or perinatal transmission of Borrelia burgdorferi in this case. The newborn showed no signs of Lyme disease at birth or during early childhood.
However, questions surrounding Lyme disease during pregnancy continue to concern many patients and families. More research is needed to better understand maternal infection, fetal risk, and long-term outcomes.
3. Diagnosis Relied on Exposure History and Testing
The diagnosis was supported by Western blot testing, which demonstrated multiple reactive bands specific to Lyme disease.
Importantly, the patient never recalled a tick bite and never noticed a rash.
This underscores a recurring problem in Lyme disease diagnosis: many patients with confirmed infection never see a tick or develop a classic bull’s-eye rash.
Clinicians should consider Lyme disease in postpartum patients with unexplained joint pain, neurologic symptoms, fatigue, or autonomic dysfunction, especially in endemic regions.
4. Symptoms Improved with Treatment
A 3-week course of doxycycline led to full resolution of the patient’s symptoms.
The authors did not explore alternative approaches that might be considered if symptoms had persisted after initial therapy.
Persistent symptoms after treatment may warrant evaluation for co-infections, immune dysregulation, or post-treatment Lyme disease syndrome (PTLDS).
Why This Case Matters
Postpartum Lyme disease may be overlooked because symptoms such as fatigue, joint pain, sleep disruption, and cognitive changes are often attributed to the normal stress of caring for a newborn.
But not every postpartum symptom is simply exhaustion.
This case highlights the importance of maintaining a high index of suspicion for Lyme disease in postpartum patients presenting with unexplained inflammatory or neurologic symptoms—particularly in endemic areas.
Early diagnosis and prompt treatment remain important to reduce the risk of prolonged illness and delayed recovery.
Frequently Asked Questions
Can Lyme disease symptoms appear after pregnancy?
Yes. Some patients report worsening or newly recognized symptoms in the postpartum period, possibly related to immune and hormonal changes after delivery.
Can pregnancy temporarily suppress Lyme symptoms?
Possibly. Pregnancy changes immune system activity, which may alter inflammatory responses and temporarily affect symptom patterns in some patients.
Can you have Lyme disease during pregnancy without knowing it?
Yes. Some patients never notice a tick bite or rash and may experience only mild or nonspecific symptoms during pregnancy.
Does this case prove congenital Lyme disease occurs?
No. In this case, the infant remained healthy and showed no evidence of congenital Lyme disease.
Should Lyme disease be considered in postpartum joint pain?
Yes—especially in endemic regions when symptoms are unexplained or accompanied by fatigue, neurologic symptoms, or prior outdoor exposure.
Clinical Takeaway
Lyme disease symptoms can sometimes emerge or worsen after pregnancy, particularly when infection was mild or unrecognized during pregnancy itself. Postpartum immune and hormonal shifts may unmask symptoms that were previously subtle or temporarily suppressed.
In endemic regions, Lyme disease should remain part of the differential diagnosis for postpartum patients with unexplained joint pain, fatigue, neurologic symptoms, or inflammatory complaints—even when there is no known tick bite or rash.
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Lyme disease misdiagnosis
References
- Pavia CS, Wormser GP, et al. An Unusual Case of Serologically Confirmed Post-Partum Lyme Disease Following an Asymptomatic Borrelia burgdorferi Infection Acquired during Pregnancy and Lacking Vertical Transmission in Utero. Case Reports in Infectious Diseases. 2018.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
