To evaluate the frequency, pattern, and severity of Lyme disease is a multisystemic infection caused by liver function test abnormalities in patients with Lyme the tick-borne spirochete, Borrelia burgdorferi. A great disease associated with erythema migrans (EM), 115 indeal of attention has been paid to the dermatologic, dividuals with no other identifiable cause for liver funcmusculoskeletal, cardiovascular, and neurological tion test abnormalities who presented with EM between manifestations of Lyme disease. 1,2 Acute hepatitis has July 1990 and September 1993 were prospectively evalubeen reported in the early stages of Lyme disease, 3-6 ated. For individuals with abnormal liver function tests, and hepatic enzyme elevations have been reported in common causes of hepatitis, including hepatitis A, B, 20% to 50% of patients with the characteristic rash of and C, were excluded. A local control group was used early Lyme disease, erythema migrans (EM). 2,7-10 Howfor comparison. Forty-six (40%) patients had at least one ever, there have been no prospective evaluations of heliver test abnormality, and 31 (27%) had more than 1 abnormality compared with 19 (19%) and 4 (4%) of con-patic dysfunction in treated patients for whom other trols, respectively (P รต .01 for each comparison). g-Gluta-major causes for liver disease were excluded. Moreover, myl transpeptidase (28%) and alanine transaminase there have been few prospective evaluations of liver (ALT) (27%) were the most frequently elevated liver function tests in a large group of patients in whom the function tests among Lyme disease patients. Anorexia, diagnosis of Lyme disease was confirmed by culture of nausea, or vomiting was reported by 30% of patients, but B. burgdorferi. To determine the frequency, severity, did not occur more frequently in patients with elevated and response to therapy of hepatitis associated with liver function tests compared with those with normal Lyme disease, we prospectively evaluated patients prevalues. Patients with early disseminated Lyme disease senting with EM for symptoms of hepatitis and liver were more likely to have elevated liver function studies function abnormalities. (66%) compared with patients with localized disease (34%) (P ร
.002). After antibiotic treatment, elevated liver PATIENTS AND METHODS function tests improved or resolved in most patients. Liver function test abnormalities are common in pa-The study population consisted of 124 consecutive untients with EM but were mild, most often not associated treated patients ยข16 years of age with a clinical diagnosis of with symptoms, and improved or resolved by 3 weeks EM who were enrolled in one of two ongoing treatment trials after the onset of antibiotic therapy in most patients. at the Lyme Disease Diagnostic Center of the Westchester (HEPATOLOGY 1996;23:1412-1417.) County Medical Center between July 1990 and September 1993. All patients fulfilled the Centers for Disease Control and Prevention surveillance criteria for EM. 11 At the initial visit, the total number, size, and duration of EM lesions were noted. All patients were questioned about the occurrence of Abbreviations: EM, erythema migrans; ALT, alanine transaminase; AST, aspartate transaminase; ELISA, enzyme-linked immunosorbent assay. anorexia, nausea, and vomiting. Patients were treated with From The 1 Department of Medicine, Divisions of 1 Infectious Diseases and either an oral doxycycline-based regimen of 100 mg twice