LIVER-FUNCTION IN EARLY LYME-DISEASE

To evaluate the frequency, pattern, and severity of liver function tes t abnormalities in patients with Lyme disease associated with erythema migrans (EM), 115 individuals with no other identifiable cause for li ver function test abnormalities who presented with EM between July 199 0 and September 1993 were prospectively evaluated. For individuals wit h abnormal liver function tests, common causes of hepatitis, including hepatitis A, B, and C, were excluded A local control group was used f or comparison, Forty-six (40%) patients had at least one liver test ab normality, and 31 (27%) had more than 1 abnormality compared with 19 ( 19%) and 4 (4%) of controls, respectively (P < .01 for each comparison ). gamma-Glutamyl transpeptidase (28%) and alanine transaminase (ALT) (27%) were the most frequently elevated liver function tests among Lym e disease patients, Anorexia, nausea, or vomiting was reported by 30% of patients, but did not occur more frequently in patients with elevat ed liver function tests compared with those with normal values, Patien ts with early disseminated Lyme disease were more Likely to have eleva ted liver function studies (66%) compared with patients with localized disease (34%) (P = .002),After antibiotic treatment, elevated liver f unction tests improved or resolved in most patients. Liver function te st abnormalities are common in patients with EM but were mild, most of ten not associated with symptoms, and improved or resolved by 3 weeks after the onset of antibiotic therapy in most patients.