Prime Time or Lyme Time: A Case of Lyme Hepatitis in the Emergency Department

Lyme disease, a tick-borne illness, is caused by the spirochete Borrelia burgdorferi. Lyme disease commonly presents with the characteristic erythema migrans rash, fever, malaise, headache, and arthralgias. Some patients may have mild liver manifestations, including abnormal liver function tests (LFTs), hyperbilirubinemia, or granulomatous hepatitis. Significant LFT abnormalities and hepatitis in a case of Lyme disease are rare. Here, we present a case of Lyme hepatitis in the emergency department (ED) where the patient presented with classic Lyme symptoms and was also found to have markedly elevated aspartate transaminase (AST) and alanine transaminase (ALT), mild alkaline phosphatase (ALP) elevation, and mild hyperbilirubinemia.