Diseases That Mimic ALS: Can Lyme Disease or Bartonella Be the Cause?

Several neurological disorders and infections can produce symptoms that resemble amyotrophic lateral sclerosis (ALS). Progressive muscle weakness, gait abnormalities, balance problems, muscle pain, and other neurologic symptoms often prompt an evaluation for ALS, multiple sclerosis (MS), or other neurodegenerative disorders. In some patients, however, an underlying infection such as Lyme disease or Bartonella may contribute to the clinical picture.

Most people evaluated for ALS do not have Lyme disease or Bartonella infection. Nevertheless, these infections occasionally produce symptoms that overlap with ALS or MS and should remain part of the differential diagnosis when exposure history, systemic symptoms, or other clinical findings raise suspicion.

In their article, Bartonella- and Borrelia-Related Disease Presenting as a Neurological Condition Revealing the Need for Better Diagnostics, Ericson and colleagues describe a woman whose illness evolved over several years before specialized testing identified both Bartonella infection and Lyme disease.¹

What diseases can mimic ALS?

Several neurological and systemic disorders may resemble ALS during the early stages of illness. Depending on the patient’s symptoms and examination, physicians may consider infectious, inflammatory, autoimmune, metabolic, or structural neurological disorders before confirming a diagnosis of ALS.

Potential ALS mimics include:

• Lyme disease
• Bartonella infection
• Multiple sclerosis (MS)
• Multifocal motor neuropathy
• Cervical spinal cord disease
• Vitamin B12 deficiency
• Inflammatory neuropathies
• Other infectious or autoimmune neurologic disorders

Because several of these conditions are potentially treatable, identifying the correct diagnosis is essential.

Can Lyme disease mimic ALS?

Neurologic Lyme disease may occasionally produce symptoms that overlap with ALS, including muscle weakness, gait disturbance, fatigue, pain, sensory complaints, and impaired balance. Although Lyme disease does not typically present exactly like ALS, it is often included in the differential diagnosis when patients have compatible symptoms together with possible tick exposure.

This distinction is important because Lyme disease is generally treatable, whereas ALS is a progressive neurodegenerative disorder.

Can Bartonella cause neurological symptoms?

Bartonella neurological symptoms may include headaches, neuropathic pain, cognitive difficulties, balance problems, blurred vision, sleep disturbances, and other neurological complaints. The pattern varies considerably from one patient to another.

Because routine laboratory testing may be negative in some patients, diagnosis can be challenging. In selected situations, clinicians may consider specialized testing together with the patient’s history, symptoms, and exposure risk.

When neurological symptoms continue to worsen despite negative routine testing, clinicians may broaden the evaluation based on the patient’s clinical presentation and exposure history.

Why can Lyme disease and Bartonella be difficult to diagnose?

Both Lyme disease and Bartonella infection may be difficult to diagnose because symptoms often overlap with many other neurological disorders. Patients may initially have nonspecific complaints such as fatigue, pain, dizziness, or cognitive difficulties before more recognizable manifestations develop.

Laboratory testing also has limitations. Test performance depends on the timing of infection, the diagnostic method used, and the organism being evaluated. As a result, physicians generally interpret laboratory findings together with the patient’s history, physical examination, and likelihood of exposure.

Why was the diagnosis delayed?

Several factors contributed to the delayed diagnosis in this case. The initial bite was believed to be a spider bite rather than a tick exposure. Standard testing for Lyme disease and Bartonella was initially negative, and the patient’s symptoms continued to evolve over time. Ultimately, specialized PCR testing identified Bartonella, followed later by evidence of Borrelia burgdorferi, illustrating how complex tick-borne infections can occasionally present.

61-year-old woman initially diagnosed with a spider bite develops progressive neurological symptoms

A 61-year-old woman experienced a painful bite while hiking in Minnesota. Because two puncture marks were present and the bite was painful, it was initially diagnosed as a spider bite.

One day later, a large blue ring developed around the bite, followed by diffuse muscle aches and joint pain.

The woman was treated with doxycycline for two weeks. Although her arthritis improved, it did not completely resolve.

Five months later, her symptoms progressed to include blurry vision, impaired balance, muscle pain, night sweats, and insomnia.

At that point, testing for both Lyme disease and Bartonella was negative.

Because she remained concerned about Lyme disease, she sought additional medical evaluation. She was referred to an infectious disease physician, who reportedly stated that he “did not believe in persistent Lyme disease.” She was subsequently referred to a neurologist for magnetic resonance imaging (MRI).

During this period, her blood was included in a research study evaluating improved PCR diagnostic techniques for Bartonella infections.

The investigational testing identified both Bartonella vinsonii and Bartonella henselae.

Approximately one year after the initial infection, the patient consulted an integrative medicine physician, who prescribed clarithromycin and rifampin based on symptoms consistent with Bartonella infection.

Despite treatment, her neurological symptoms continued to worsen.

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Her neurological symptoms continued to progress, and she was referred to a physical therapist, who recommended a wheeled walker because of worsening mobility. Her primary care physician considered whether she might have amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS).

She also reported that her hips “sounded like popcorn” whenever she walked or climbed stairs.

Hip radiographs demonstrated severe cartilage loss with bilateral hip degeneration, ultimately requiring hip replacement surgery.

Before surgery, the patient underwent another round of testing for Bartonella. Once again, specialized testing confirmed the presence of Bartonella.

In addition, examination of a buffy coat smear revealed “a spirochete-like organism.”

“Given her symptomology and the known possibility of co-infections in Lyme disease, the spirochete was suspicious for Borrelia burgdorferi.”

Subsequent testing confirmed Lyme disease.

Once treatment directed at Lyme disease was started, the patient’s condition improved clinically.

However, the authors noted that “despite the intermittent use of antibiotics for five years, the patient remains positive for Bartonella henselae and Borrelia burgdorferi.”

Whenever antibiotic therapy was discontinued, her symptoms reportedly recurred within approximately three months.

Authors’ Conclusions

• “This case report illustrates the inadequacy of conventional tests in diagnosing Bartonella spp. infections, and the potential promise of enhanced techniques.”
• Although serologic testing is commonly used to diagnose both Bartonella and Borrelia infections, this patient repeatedly tested negative by standard antibody testing while specialized FISH and PCR methods were positive.
• “The limitations of serology for detecting an active infection need to be more clearly understood by the medical community.”

Frequently Asked Questions

Can Lyme disease mimic ALS?

Yes. Neurologic Lyme disease may occasionally resemble ALS because both conditions can involve progressive weakness, gait abnormalities, fatigue, muscle pain, and balance problems. Lyme disease should be considered when the history, exposure risk, and accompanying symptoms are compatible with tick-borne illness.

Can Bartonella cause neurological symptoms?

Yes. Bartonella neurological symptoms may include neuropathic pain, headaches, cognitive impairment, blurred vision, balance problems, sleep disturbances, and weakness. Symptoms vary considerably among patients.

Can Lyme disease and Bartonella occur together?

Yes. Co-infections have been reported in patients exposed to ticks carrying multiple pathogens. When present, co-infections may complicate both diagnosis and treatment.

Why can Lyme disease and Bartonella be difficult to diagnose?

Diagnosis depends on the timing of infection, the laboratory method used, and the patient’s clinical presentation. Negative laboratory tests do not always exclude infection, so clinicians generally interpret test results together with the patient’s symptoms, physical examination, and exposure history.

Can Bartonella mimic multiple sclerosis?

Some patients with Bartonella infection develop neurological symptoms that overlap with multiple sclerosis, including balance problems, weakness, sensory complaints, and visual disturbances. These findings are not specific to Bartonella, and a comprehensive neurological evaluation is necessary before establishing a diagnosis.

Clinical Takeaway

This case report illustrates how Lyme disease and Bartonella infection may occasionally resemble progressive neurological disorders such as ALS or multiple sclerosis. Although this represents a single patient and should not be generalized to everyone with neurological symptoms, it underscores the importance of maintaining a broad differential diagnosis when exposure history, systemic symptoms, or an atypical clinical course raises suspicion for a treatable infectious condition.

When evaluating diseases that mimic ALS, clinicians should consider Lyme disease, Bartonella infection, and other potentially treatable neurological disorders alongside more common neurodegenerative diseases.

Related Articles

Continue learning about Lyme disease, Bartonella, and neurological complications:

Bartonella: symptoms, diagnosis, and treatment
Neurologic Lyme disease: symptoms and diagnosis
Why Lyme disease is frequently misdiagnosed
Lyme disease symptoms: a clinical guide
Persistent Lyme disease: understanding ongoing symptoms

References

1. Ericson ME, Mozayeni BR, Radovsky L, Bemis LT. Bartonella- and Borrelia-Related Disease Presenting as a Neurological Condition Revealing the Need for Better Diagnostics. Microorganisms. 2024;12(1):209.

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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