Dr. Shubadeep Debabrata Sinha
Infectious Diseases
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Patient's Query
Hello doctor,
Over a year, I have had polyclonal B cell activation, elevated IgM, and positive ANA with systemic flu-like symptoms. However, the reports are confusing. They suggest that ANA was positive six times but negative twice (homogenous pattern 1:320), ENA and dsDNA were negative, complements normal, FBC normal with low MPV, ESR normal, CRP normal, liver and kidney function normal, urinalysis has leukocytes +1 but otherwise normal, EBV, CMV, hepatitis, HIV, syphilis, streptococcus, and H pylori tests are negative, ELISA for Lyme disease positive, however, western blot was negative. Hematology reports do not conclude it is cancer. Other autoimmune diseases like MS, Hashimoto's, graves disease, hepatitis, myasthenia gravis, celiac disease, arthritis, diabetes, IBD, and Addison's disease have been ruled out. Chest CT is normal. CT's abdomen shows a swollen spleen.
I have symptoms of fatigue, Raynaud's syndrome, skin rashes that subside with steroid creams, petechiae, livedo reticularis, episcleritis of the eye, muscle aches, joint pain (throbbing around knees), headaches and migraines, fever and chill episodes, hair loss, mouth ulcers, and light-headedness. The symptoms are worsening with time. Can you please guide me on the reason for these symptoms? Are they because of an infection, an autoimmune disease, or Lyme ELISA?
Kindly help.
Hello,
Welcome to icliniq.com.
Thank you for the query. I understand your concern and would be happy to help.
Your condition appears inflammatory, as it has both infective and autoimmune features. The causative agent of lyme disease is a bacteria called borrelia burgdorferi. The disease in its early stages is mainly associated with viable bacteria at the site of inflammation. In contrast, in the later stages of the disease, autoimmune features seem to contribute significantly.
Therapeutic strategies using antibiotics are usually successful, but the chronic disease may require immunosuppressive treatments with steroids, oral or local immunosuppressive drugs, and monoclonal antibodies.
Kindly send all the test reports you mentioned in your query to help guide you better.
Thank you.
The Probable causes
Patient's Query
Hello doctor,
Thank you for your reply.
I have attached the blood and scan reports.
Can someone with lyme disease have a positive boreilla antibody ELISA and a negative western blot? During my last appointment, my doctor suggested that it can be either UCTD, lyme disease, or another infection. However, most infections have already been ruled out. Do I need to go for any other tests to diagnose my condition?
Kindly suggest.
Hello,
Welcome back to icliniq.com.
When the rash is atypical, or exposure to the appropriate tick species is unlikely, diagnosis is based on serological response to Borrelia burgdorferi. Immunoglobulin (Ig) M antibodies are detected within weeks of the onset of symptoms; however, a significant proportion of patients may not have detectable antibodies during the initial presentation. Additionally, when patients are treated very early in the illness, antibodies may not develop. When an initial antibody determination is negative, a second serum specimen is suggested to be collected after four weeks and retested. As Lyme disease can be treated with antibiotics like Doxycycline, the therapy can be started.
Current evidence suggests that commercially available enzyme immunoassays (EIAs) used for screening are sufficiently sensitive (beyond the first month of infection). However, enzyme-linked assays ( ELISA) that are presently in use lack the specificity necessary to base a lyme disease diagnosis on an unconfirmed result. Consequently, confirming initial EIA screening results with a western blot test (the two-step approach) is recommended.
You also have signs that suggest pulmonary hypertension and restrictive lung disease. The symptoms of inflammatory diseases are ANA (anti-nuclear antibodies) and enlarged spleen.
An anti-inflammatory regimen can be followed to treat the autoimmune condition.
I hope this helps.
Thank you.
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