Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neurological disorder involving inflammation of nerve roots and peripheral nerves and destruction of the protective myelin sheath covering the nerves. It causes progressive weakness and impaired sensory function in the legs and arms.
This case demonstrates how CIDP can be triggered by Lyme disease — and how antibiotic treatment resolved what immunoglobulin therapy could not.
The Case: CIDP Misdiagnosed for 10 Months
A woman presented with asthenia, weakness, and diffuse paresthesias. Electromyography showed mild demyelination. Lyme disease was initially ruled out based on negative serum and cerebrospinal fluid serologic tests.
She received intravenous immunoglobulin treatment 8 times for CIDP with partial response and relapse each time.
Lyme Disease Diagnosed After Serology Failed
Lyme disease was finally diagnosed 10 months after the onset of symptoms — not through standard serology, but when a serum polymerase chain reaction (PCR) analysis disclosed the presence of Borrelia (100 copies/mL).
This case illustrates a critical point: negative Lyme serologic tests do not always rule out Lyme disease. The standard two-tier testing missed this patient’s infection entirely.
Antibiotics Resolved What Immunoglobulin Could Not
The woman was treated with 6 weeks of doxycycline and hydroxychloroquine. She showed dramatic clinical improvement with complete disappearance of neurologic signs, according to Perronne.
After 8 rounds of immunoglobulin therapy produced only partial and temporary improvement, antibiotic treatment targeting the underlying Lyme infection resolved the CIDP completely.
Why This Case Matters
- CIDP can be caused by Lyme disease — even when standard serologic tests are negative
- PCR testing detected Borrelia that serology missed
- 10 months of immunosuppressive treatment failed because the underlying infection was not addressed
- Antibiotic treatment produced complete resolution of neurologic symptoms
- The authors warn against automatically ruling out Lyme disease based on negative serology
The authors stated that in their opinion, negative Lyme serology is insufficient to rule out early or late chronic Lyme disease diagnosis.
For a comprehensive overview of how Lyme disease affects the nervous system, see Lyme Disease Neuropathy: Symptoms and What Causes It.
Frequently Asked Questions
Can Lyme disease cause CIDP?
Yes. This case report documents CIDP triggered by Lyme disease, with complete resolution after antibiotic treatment.
Can CIDP be cured with antibiotics?
When CIDP is caused by an underlying infection like Lyme disease, treating the infection can resolve the polyneuropathy. In this case, 6 weeks of antibiotics succeeded where 8 rounds of immunoglobulin therapy had failed.
Can Lyme disease be missed on standard blood tests?
Yes. In this case, both serum and cerebrospinal fluid serologic tests were negative. Lyme disease was only detected through PCR testing 10 months later.
What is CIDP?
Chronic inflammatory demyelinating polyneuropathy is a neurological disorder involving inflammation and destruction of the myelin sheath covering peripheral nerves. It causes progressive weakness and sensory impairment in the arms and legs.
How is CIDP different from other forms of Lyme neuropathy?
CIDP involves demyelination — destruction of the nerve’s protective coating — rather than small fiber damage. It causes more prominent weakness and reflex changes compared to small fiber neuropathy.
References
- Perronne C, Lacout A, Marcy PY, El Hajjam M. Errancy on Lyme Diagnosis. Am J Med. 2017;130(5):e219.
- Cameron DJ. Consequences of treatment delay in Lyme disease. J Eval Clin Pract. 2007;13(3):470-472.
- National Center for Advancing Translational Sciences. rarediseases.info.nih.gov.
I had a positive IGG western blot test in May 2020 after receiving multiple ticks bites in the Dordogne region of France over a period of several years. No rash was ever detected.
Symptoms elevated in the last 3 months seem to be an exact replica of those described in this article, however the doctors in Norway, where my my MRI and lumbar puncture were performed expressed that the mild demyelination that showed was indicative of a “ normal” result for my age (55). Even though borrelia antibodies were found in the spinal fluid it was assessed as being negative for borreliosis. It seems very difficult to confer with a LLMD in Europe and they do not exist in Scandinavia. I am currently still on a two month waiting list with a LLMD in the Netherlands. It would be so helpful to speak with someone who has expertise in this field.
How are you doing now Lisa? Were you able to locate a reputable physician(s) interested in considering your case of CIDP related to Lyme borreliosis? Please be careful regarding so called LLMD’s. They are often self-proclaimed and are prone to self-promotion through dubious methods. Be particularly wary of doctors who demand payment, some in cash, upfront. That’s a clear indicator in the US at least, that the physician probably uses treatment(s) that are considered “alternative” at best and most importantly, have not been subjected to scientific scrutiny. I pray you are doing better.