Negative Lyme Disease Test: A Case Study

Dr. Cameron believes one of the best ways to understand Lyme disease is by reviewing real clinical cases. In this Inside Lyme Podcast episode, he discusses a 75-year-old Chinese man whose illness was initially missed after a negative Lyme disease test.

Lyme disease testing can sometimes be misleading, particularly early in illness or when clinicians rely only on screening tests. A negative Lyme disease test does not always rule out infection. This case illustrates how a false negative Lyme disease test may delay diagnosis.

This case was first reported by Lamichhane and colleagues in the journal Case Reports in Infectious Diseases in 2018.

The 75-year-old man presented with a high fever, unsteady gait, encephalopathy, diffuse muscle pain, and tachycardia.

Initial testing for Lyme disease was negative. The physicians apparently did not request a confirmatory Western blot after the initial screening test.

As the patient’s condition worsened, the doctors ordered additional laboratory tests beyond the initial Lyme disease screening test.

Follow-up testing revealed that the patient was positive for Lyme disease. He was also found to have evidence of Babesia, a tick-borne parasite that commonly occurs as a coinfection with Lyme disease.

The patient was treated for Lyme disease and improved clinically according to the authors.

However, he was not treated for Babesia.

I was concerned about the untreated Babesia infection, since coinfections can complicate Lyme disease and contribute to persistent symptoms.

Learn more about tick-borne coinfections such as Babesia in my overview of Babesia infection. Neurologic complications of Lyme disease are discussed in my overview of neurologic Lyme disease. You can also review the broader discussion of Lyme disease testing accuracy.

Clinical Takeaway

This case highlights an important lesson: a negative Lyme disease test does not always exclude infection. When clinical suspicion is high, clinicians may need to pursue additional testing and consider tick-borne coinfections.

Delayed recognition of Lyme disease or Babesia coinfection may lead to worsening symptoms or complications.

Inside Lyme Podcast Series

You can hear more case discussions through Dr. Cameron’s blog, social media channels, and YouTube videos.

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Disclaimer: The information provided in this podcast is for educational purposes only and is not intended as medical advice for any individual patient. Patients should consult a qualified healthcare professional for diagnosis and treatment.

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention