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

## TL;DR

A rare case of Lyme disease causing liver inflammation is presented, highlighting unusual symptoms in the emergency department.

## Contribution

This paper reports a rare case of Lyme hepatitis, emphasizing its presentation in the emergency department.

## Key findings

- The patient exhibited classic Lyme disease symptoms alongside significant liver enzyme elevations.
- Lyme hepatitis is rare, with only mild liver manifestations typically observed.
- Emergency department recognition of Lyme-related liver dysfunction is highlighted.

## Abstract

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.