When Lyme Disease Is Missed: A Case from My Practice

A Lyme disease missed diagnosis often begins quietly—when key diagnoses are never considered. Just a couple of weeks ago, I had a new patient on my schedule—someone who specifically requested a consultation for Lyme disease.

Before the visit, I reviewed her chart, expecting to see at least some evaluation for tick-borne illness. She had already seen multiple specialists, including rheumatology, neurology, and infectious disease. Her records documented a long list of symptoms: fatigue, brain fog, joint pain, palpitations, headaches, and what she described as “air hunger.”

But one thing stood out immediately.

There was no Lyme disease evaluation.

No Western blot. No co-infection testing. No documentation that tick-borne illness had even been considered.

She lived in a high-risk area. She spent time outdoors. Her symptoms followed a recognizable post-infectious pattern. And yet Lyme disease was not on the radar.

This is how a Lyme disease missed diagnosis often begins—not with overt denial, but with omission. I discuss this pattern in detail in my article on Medical Dismissal in Chronic Lyme Disease.

It Begins With What Isn’t Asked

When she arrived, she described a slow, progressive decline that began nearly a year earlier after a summer hike. She did not recall a tick bite. She never noticed a rash. But she developed a flu-like illness, followed by symptoms that never fully resolved.

Over time, her condition worsened.

She was treated for anxiety. Prescribed medications for sleep and inflammation. Evaluated for autoimmune disease and neurologic conditions, including lupus and multiple sclerosis. Each evaluation ruled something out—but nothing explained the full picture.

This fragmented approach is common when Lyme disease is never fully reconsidered.

Looking for What Had Been Missed

We started from the beginning.

I took a detailed exposure history, mapped the evolution of her symptoms, and looked for connections rather than isolated complaints. Based on the full clinical picture, I ordered what should have been considered much earlier:

• Lyme disease IgM and IgG Western blot
• Babesia and Bartonella testing
• Repeat bloodwork and inflammatory markers

This was not guesswork. Lyme disease remains a clinical diagnosis, guided by history, exposure risk, and symptom patterns—not algorithms or shortcuts.

The Results—and a Turning Point

When the results returned, they were revealing.

Her Lyme IgG Western blot was positive, with 6 of 10 bands. She also tested positive for Babesia duncani IgG.

She did not have Lyme disease alone. She had a co-infection—one that requires a completely different treatment strategy. This explained why the brief course of doxycycline she received months earlier had not helped. Babesia does not respond to doxycycline.

We began treatment with atovaquone and azithromycin. For the first time in months, she felt there was a plan—and a sense of direction.

For patients with air hunger, night sweats, and treatment-resistant symptoms, Babesia is often overlooked. You can read more in Babesia: The Overlooked Lyme Co-Infection.

A Repeating Pattern

This was not an unusual case.

Patients with Lyme disease and co-infections often fall through the cracks of a fragmented healthcare system. Symptoms are attributed to anxiety or stress. Testing is delayed, incomplete, or denied. Care is spread across multiple specialists, with no one responsible for integrating the full story.

A Lyme disease missed diagnosis does not always sound dismissive. Often, it sounds like reassurance without resolution.

I see this repeatedly in patients who continue to experience symptoms after standard treatment—particularly when co-infections, immune responses, or other contributing factors are never reassessed. I discuss this complexity in Why Some Patients Don’t Improve After Lyme Treatment.

Public health agencies acknowledge that symptoms may persist after treatment, including guidance from the Centers for Disease Control and Prevention (CDC).

Closing the Gap

Lyme disease requires careful listening, pattern recognition, and the willingness to ask a simple but essential question:

What if something important has been missed?

This patient did not need reassurance that her tests were normal. She needed someone to consider what had not yet been tested—and to put the pieces together.

When Lyme disease and co-infections are recognized earlier, outcomes improve. When they are missed or overlooked, patients lose time, confidence, and health.

This case is not about blame. It is about awareness—and the cost of omission.