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Would Lyme or Bartonella Cause a Positive Punch Biopsy?

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Posted 3/15/2023 6:29 PM (GMT 0)
I've had a positive EMG and Nerve Conduction Study, indicating I have large fiber neuropathy, which has caused a lack of reflex response and it is harder to feel a vibration on parts of my feet and ankles.

But neither of those tests can test for small fiber neuropathy. For that, a punch biopsy is needed. I had that performed about 9 months ago, and it was negative. Yet, I have burning and pain in feet, which, according to all I've researched for months, is caused by small fiber damage.

That leads to the question in my subject in headline. I do have Sjogren's Syndrome, which can cause both large and small fiber neuropathy, along with autonomic, but the negative punch biopsy for small fiber throws me.
Posted 3/15/2023 8:31 PM (GMT 0)
yes i think it could - because they can cause pretty much any auto-immune disease - which i think SFN normally is - But your punch test was negative - right ?

so are you asking - "Could bart and/or lyme cause SFN like subjective symptoms - burning, tingling numbness, pain, etc - but without a positive punch test for SFN?"

here again i would say yes - bart is long known to be associated with various pain syndromes and forms of nerve damage - and Lyme in particular is known for its ability to inflame and damage nerves - both big ones as in cranial nerve palsy, or radiculitis - and for tingling, burning pain sensations eg the smaller nerves in the skin -

this table shows other things that are known to drive SFN

Potential causes of small fiber neuropathy and related testing

Causes of small fiber neuropathy Evaluation
Diabetes, impaired glucose tolerance 2-h glucose tolerance, HgbA1c
Sjogren’s syndrome SS-A, SS-B, salivary gland biopsy
Lupus connective tissue disease ANA, ANCA
Sarcoidosis ACE level
Vitamin B12 deficiency B-12, methylmalonic acid, homocysteine
Celiac disease Gliadin and transglutaminase antibody
HIV HIV serology
Paraprotein/amyloid Serum immunofixation, quantitative immunoglobulins
Alcohol abuse History
Chemotherapy History

the same paper is v pro punch biopsies - and claims an 88-92% sensitivity for the test
thats pretty good compared to lyme testing for instance - but not perfect - will miss 1 in 10

so its possible to have SFN and not test positive on the punch biopsy - though i do not know what the gold standard they use in this case as reference

reading the paper it seems like its very much a sliding scale - done by simply counting the number of nerve fibres in a certain area - and calling the result positive if its below a certain threshold - so its possible to have some level of damage to the nerves without a positive result

https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4348533/#!po=46.4286
Posted 3/16/2023 3:47 PM (GMT 0)
Garzie - Your rely hit on exactly what I was asking, though zi should have done a better job wording to be more specific.

It was surprising when the punch biopsy came back negative as I also have burning and pain, but no loss of feel in my feet or ankles.

With the positive EMG and nerve conduction study, there is no doubt LFN is there. But it doesn’t explain the burning, which I was hoping the punch biopsy would do.

There is no doubt, to me, the large fiber neuropathy is caused by the Sjogrens. So I am thrown by the negative punch. That led to my question - could Bart cause one and Sjogrens the other since the punch was negative? Or was it a false positive, even though specificity and sensitivity are high with punch biopsies? No way of knowing that without a second one, which I am going to ask to have performed.

More we know, the more tweaking in therapy can be done.
Posted 3/16/2023 4:39 PM (GMT 0)
yep, my guess is the pathological process at work is something along the lines of :

infections =>immune disruption => autoimmunity ( general) => autoimmune diseases ( specific )

so, i would say that Sjogrens and LFN and SFN (formally diagnosed or subclinical ) are all all downstream results of the immune system disruption caused by the infections you have tested positive for - rather than unconnected stand alone conditions - as specialists sometimes seem to think of them as
Posted 3/16/2023 7:09 PM (GMT 0)
It makes total sense. It will s estimated about half of one percent of the population ends up with Sjogrens. Of those who end up with Sjogrens, 90% are women.

So the odds of a man getting Sjogrens is near 0. No doubt injections or Epstein Barr, which also can be caused by infections, is cause. The only riddle to solve is why the skin biiopsy was negative. If a second one is also negative, then there is the possibility two things are involved.

No doubt about autoimmune is real here and causing large fiber and, probably, autonomic neuropathy. So a second biopsy being negative would be confusing. My bet is a second one would be positive.

If not, then that sets up the possibility of infection causing SFN and autoimmune causing LFN. Again, I’m betting a second punch will be positive and tie it all together. Thanks
Posted 3/17/2023 1:16 AM (GMT 0)
Not sure this is that weird tbh RW

The punch biopsy is often negative early. Mine was in 2019, now I can barely feel my feet 😂🥺😂

Other possibility is that large fiber damage can cause burning as well no? But I don’t suspect that’s the issue would imagine you have sfn alls well
Posted 3/17/2023 4:13 PM (GMT 0)
Agree with much of what you are saying, dcd. My guess is it is SFN. Have had some burning and “crunchy” feeling in feet for a few years now. It’s just in my nature to seek clarification. Just had candida positive, which I’ve been believing I have had for several years.

Everything I can find and what neurologist has said is large fiber neuropathy causes the loss of vibration and reflex. I guess my nature looks for as much confirmation as possible. Wouldn’t surprise me to get a positive on second biopsy, but a second negative now would raise questions.

But there is no doubting autoimmune.
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