Unusual Case Cites Infection as Possible Trigger of Sarcoidosis

A study reporting the case of a sarcoidosis patient infected with the bacteria Borrelia burgdorferi highlights the importance of maintaining an increased awareness about potential infectious conditions, such as Lyme disease, in patients with new onset of sarcoidosis.

The case study, “Systemic Sarcoidosis Associated with Exposure to Borrelia burgdorferi in a 21-Year-Old Man,” was published in the European Journal of Case Reports in Internal Medicine.

Sarcoidosis is characterized by a buildup of immune cells in structures called granulomas in different parts of the body. Although the disease’s exact cause is unknown, sarcoidosis-associated symptoms such as skin and kidney problems result from immune cells attacking body tissues, many times following an infection.

Previous studies have shown associations between sarcoidosis and B. burgdorferi, a Lyme disease-causing bacterial species. Lyme disease is an infectious disease spread by ticks.

Now, a team in The Netherlands reported the case of a patient diagnosed with systemic sarcoidosis and with a recent infection by B. burgdorferi.

The patient was a 21-year-old male forestry worker who went to an emergency room after experiencing increasing swelling, redness, and skin peeling in both legs. The man had experienced headaches behind the eyeball and a droopy left eyelid a few months earlier.

Other symptoms included fatigue, thirst, loss of appetite, and weight loss. The patient also had elevated levels of creatinine (a waste product produced by muscle metabolism) and calcium (hypercalcemia), both indicating sarcoidosis-related kidney problems.

Chest X-rays showed bilateral hilar adenopathy, an enlargement of the lymph nodes on the root of the lungs (the hilum). Further lymph node analysis and skin biopsies also showed the presence of non-caseating granulomas, a hallmark of sarcoidosis. Collectively, the findings confirmed a diagnosis of systemic sarcoidosis affecting the lungs, skin, and kidneys.

The patient was then started on a high-dose immunosuppressive prednisolone treatment (a corticosteroid used to treat sarcoidosis symptoms). The prednisolone therapy normalized the calcium levels and kidney function after two days of treatment.

Because of his profession as a forestry worker (exposing him to tick bites) and unexplained headaches, the team tested the patient for Lyme disease. Serum assessments showed the presence of IgG antibodies (the most common type of antibody in the blood) against B. burgdorferi, and a positive cerebrospinal fluid/serum ratio.

These results suggested neuroborreliosis — a neurological display of Lyme disease.

To prevent a possible flare-up of temporarily inactive B. burgdorferi, the patient subsequently received two weeks of intravenous ceftriaxone followed by one month of doxycycline treatment (two antibiotics) alongside the prednisolone treatment.

The patient recovered quickly within a few days after starting prednisolone treatment, and was discharged free of symptoms and in good health.

Overall, “this case suggests that an infection with B. burgdorferi, the causal agent of Lyme disease, could act as a trigger for sarcoidosis,” researchers said.

The team also emphasized the need to “maintain a high index of suspicion for underlying infectious processes like neuroborreliosis in patients with new onset sarcoidosis before starting immunosuppressive regimens.”