LIVER and LYME DISEASE

Lyme disease is a multisystem disorder caused by the tick-borne spirochete, Borrelia burgdorferi.

Malaise, fever, myalgia, lymphadenopathy and a distinctive rash: erthema chronicum migrains

Lyme disease may also cause hepatitis:

• In 314 patients with early Lyme disease seen at Yale university, abnormal LFT's in 19%, usually transaminases [1]
• In a study from NY state (with a control group): 40% [2].
• In a study from Connecticut: 27% [3].
• Most frequently GGT and ALT, but jaundice has been described [4], [5]

Symptoms occur: nausea, anorexia, weight loss and right upper quadrant pain.

Present within days to weeks after the onset of illness, often in association with the characteristic rash of early Lyme disease: erythema chronicum migrans (time of dissemination).

Can be directly seen on liver biopsy [6].

Granulomatous hepatitis associated with Lyme disease [7]

Liver function test abnormalities are common in patients with erythema migrans but were mild, most often not associated with symptoms and improved or resolved by 3 weeks after the onset of antibiotics (tetracycline) [2], [6].

References:

1. Steere AC, Bartenhagen NH, Craft JE, Hutchinson GJ, Newman JH, Rahn DW, Sigal LH, et al. The early clinical manifestations of Lyme disease. Ann Intern Med 1983; 99: 76-82.
2. Horowitz HW, Dworkin B, Forseter G, Nadelman RB, Connolly C, Luciano BB, Nowakowski J, et al. Liver function in early Lyme disease. Hepatology 1996; 23: 1412-7.
3. Kazakoff MA, Sinusas K and Macchia C. Liver function test abnormalities in early Lyme disease. Arch Fam Med 1993; 2: 409-13.
4. Edwards KS, Kanengiser S, Li KI and Glassman M. Lyme disease presenting as hepatitis and jaundice in a child. Pediatr Infect Dis J 1990; 9: 592-3.
5. Cunha BA. Systemic infections affecting the liver. Some cause jaundice, some do not. Postgrad Med 1988; 84: 148-58, 161-3, 166-8.
6. Goellner MH, Agger WA, Burgess JH and Duray PH. Hepatitis due to recurrent Lyme disease. Ann Intern Med 1988; 108: 707-8.
7. Chavanet P, Pillon D, Lancon JP, Waldner-Combernoux A, Maringe E and Portier H. Granulomatous hepatitis associated with Lyme disease. Lancet 1987; 2: 623-4.

December 19, 2001

For more information go to: Homepage J-F. Dufour, http://www.cx.unibe.ch/ikp/lab7/personJFD.html

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