I too had a butterfly rash and an elevated ANA (but no Lupus-specific antibodies). But I didn't have enough symptoms of Lupus to qualify for that diagnosis so the doctor told me I had an Undifferentiated Connective Tissue Disorder (UCTD), and then my PCP told me she thought the UCTD was "Lupus-Like" but was secondary to something else (she had no idea what it was secondary to, & neither did any of my other doctors at the time). When I tested positive for Lyme, that answered the question of what the UCTD was secondary to in my mind (and in the minds of the LLMD & LLND's I've seen since).
It is known that Lyme can cause an elevated ANA and a butterfly rash. It is also known that Lyme is primarily a clinical diagnosis because of the unreliability of the tests available. Some LLMD's prefer to see if there is a response to treatment first before running a confirmatory test because of this, and because sometimes a few weeks of antibiotics can actually cause the body to start generating antibodies to the Lyme and thus gives a more meaningful Lyme test result.
Just my $.02...take care,
Chronic Lyme Disease, Gluten & Sulfite Sensitivity, Many Food/Inhalant/Medication/Chemical Allergies & Intolerances, Asthma, Gut issues (dysmotility, non-specific inflammation), UCTD ("Secondary Lupus-Like Syndrome"), Osteoporosis, Pancytopenia, chronic malabsorption/malnutrition, etc.; G-Tube; Currently TPN-dependent.
Meds: Zofran, Pulmicort, Heparin (to flush PICC line), Claritin, Colloidal Silver (used topically), IV Milk Thistle, probiotics.