Lyme Disease

Case studies and reviews of Lyme disease describing how this vector-borne infection manifests in some patients as dermatomyositis and polymyositis, as well as other connective tissue diseases.

Clinical pathologic correlations of Lyme disease by stage. Ann N Y Acad Sci. 1988;539:65-79

Report describing the immunologic damage caused by late stage manifestations of Lyme, suggestive of collagen-vascular diseases, such as scleroderma, lupus, polymyositis, and dermatomyositis, as seen on histologic examination of tissue samples.  Dr. Alan Steere (rheumatologist) and Dr. Paul Duray suggest that this type of damage is in response to persistence of the causative organism of Lyme disease, a spirochete, called Borrelia burgdorferi (Bb), “… however few in number.”

Acute lyme infection presenting with amyopathic dermatomyositis and rapidly fatal interstitial pulmonary fibrosis: a case report. J Med Case Rep. 2010 Jun 21;4:187. doi: 10.1186/1752-1947-4-187.

A case of amyopathic (lack of muscle disease) dermatomyositis in a 64-year-old African American male with co-morbidities (prostate cancer, COPD and Hep C), diagnosed with Lyme disease upon presenting with an erythema migrans (bulls-eye) rash and positive serology for the infection. After treatment for acute infection with two weeks of doxycycline and steroids for polyarthralgia, he was admitted with weakness of proximal muscles in lower and upper extremities, shortness of breath with rapidly progressing interstitial lung disease, dermatitis to face and palms and weight loss. Testing for dermatomyositis was thought to be abrogated by steroid therapy, but other positive serology included mildly elevated transaminases, ANA 1:40, positive anti JO-1 antibody. In spite of aggressive steroidal, antimicrobial, bronchodilator therapy, and intubation, the patient died a week later.

Additional Medscape commentary.

Dermatomyositis associated with Lyme disease: case report and review of Lyme myositis. Clin Infect Dis. 1994 Feb;18(2):166-71.

Report of a case of Lyme-induced dermatomyositis of a patient, resident in New York, presenting with multiple erythema migrans rashes and seropositive for Lyme disease. The study authors also report on the clinical presentation of this case and treatment responses of patients with Lyme myositis.

Lyme disease in a 74-year-old forest owner with symptoms of dermatomyositis. Arthritis Rheum. 1995 Aug;38(8):1157-60.

A case is described of a 74-year-old forest owner who developed dermatomyositis that was determined to have been triggered by Lyme disease, as diagnosed by positive serology, spirochetes seen in muscle tissue by silver staining, and PCR testing of a skin biopsy. The authors state that Lyme should be considered in differential diagnostic work-up as this tickborne infections has the capability of mimicking and triggering dermatomyositis.

[Lyme disease could mimic dermatomyositis]. Rev Med Interne. 2007 May;28(5):343-5. Epub 2007 Jan 26.

Case of a woman with a 5-month history of signs and symptoms suggestive of dermatomyositis, and confirmed by laboratory studies and muscle biopsy.  Testing for Lyme disease also proved positive by serology and the woman was successfully treated with doxycycline. Authors state that Lyme disease should be considered as a differential diagnosis of dermatomyositis.

Molecular detection of persistent Borrelia burgdorferi in a man with dermatomyositis. Clin Exp Rheumatol. 1992 Jul-Aug;10(4):387-90.

Case of a 40-year-old male with pre-existent dermatomyositis contracted Lyme disease after a tick bite. After treatment with tetracycline and resolution of infection symptoms, a dermatomyositis flare was difficult to control. Antibiotic therapy (ampicillin) was reinitiated, along with probenecid and cytotoxic therapy, after Lyme was detected in the patient’s peripheral blood leucocytes by PCR testing – all other testing for Lyme was negative, including western blot. The patient responded well and subsequent PCR testing was negative. This case demonstrates the immune-modulatory effects of Lyme spirochetes and the authors conclude that PCR testing may prove to be a valuable tool in testing for Lyme in persistent, seronegative Lyme disease and immune-compromised individuals.

[Atypical form of Lyme disease]. Pan Afr Med J. 2015 Jun 9;21:100. doi: 10.11604/pamj.2015.21.100.6354. eCollection 2015.

Note: This study is in French and may be translated to English using the Google Translate tool.

The case of a 37-year-old woman with dermatomyositis, confirmed by serology, worsened upon initiation of high dose corticosteroid therapy and had to be admitted to hospital. An infectious disease work-up resulted in positive results for Lyme disease. Antibiotic therapy was initiated with full resolution of all dermatomyositis disease signs and symptoms. The authors state that it is imperative to complete a full differential diagnostic workup to ensure appropriate treatment and to avoid unnecessary complications.

[The dermatologic spectrum of Lyme borreliosis]. Wien Med Wochenschr. 1995;145(7-8):165-70.

Discussion of the typical and atypical dermal presentations of Lyme disease. Atypical presentations that can be clinically diagnosed, include erythema migrans, borrelia lymphocytoma and acrodermatitis and chronica atrophicans (ACA). However, atypical Lyme dermatoses, diagnosed by skin biopsy culture, include, dermatoses of unknown origin, such as circumscribed scleroderma, dermatomyositis-like syndrome, relapsing nodular panniculitis, granuloma anulare, and roseolar erythemas. The author recommends new standardized diagnostic procedures to define the spectrum of skin diseases caused by Lyme disease and that new therapeutic antibiotic strategies have proven to be successful in treating these dermal manifestations.

[Acute reversible degenerative myopathy complicating Lyme disease: description of a case]. Infez Med. 1998;6(2):96-98.

Italian study authors state that Lyme disease can resemble other infections or autoimmune processes and present a case of acute, first-stage Lyme disease-induced dermatomyositis.

Coexistent dermatomyositis, relapsing polychondritis, and positive Lyme serology. A case-report. Rev Rhum Engl Ed. 1997 Oct;64(10):589-90.

No abstract available for the following study but may be available by registering for the journal.

Lyme disease: musculoskeletal manifestations. Rheum Dis Clin North Am. 1989 Nov;15(4):649-56.

In this commentary by the Section of Rheumatology, University of Minnesota School of Medicine, Minneapolis, the authors state that Lyme disease, while closely resembling reactive arthropies, it has also mimicked  other connective tissue disorders, such as juvenile rheumatoid arthritis, rheumatoid arthritis, myositis, and scleroderma.


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