Atypical Lyme Disease Symptoms: Numbness, Tingling, and Weakness
Lyme disease can cause neurologic symptoms beyond the classic rash
Numbness, tingling, abdominal weakness, and urinary symptoms may reflect Lyme neuroborreliosis
A New England Journal of Medicine case highlights why these atypical symptoms should not be overlooked
Atypical Lyme disease symptoms can include numbness, tingling (paresthesia), weakness, abdominal wall weakness, urinary symptoms, and radicular pain. Because these symptoms often resemble spinal disorders, peripheral neuropathy, or other neurologic diseases, Lyme disease may initially be overlooked.
A case report by Reda and colleagues in the New England Journal of Medicine described a 58-year-old woman who developed progressive numbness, weakness, abdominal wall dysfunction, and urinary symptoms caused by Lyme meningoradiculitis, an uncommon manifestation of Lyme neuroborreliosis.
The case demonstrates how Lyme disease can inflame nerve roots and peripheral nerves, producing symptoms that may mimic lumbar spine disease, diabetic neuropathy, multiple sclerosis, or other neurologic disorders.
Atypical Lyme Disease Symptoms in a 58-Year-Old Woman
The patient was evaluated in an outpatient neurology clinic in early autumn because of hypoesthesia (reduced sensation), paresthesia (tingling), and weakness.
Her illness began 10 weeks earlier with pain between her shoulder blades. The discomfort resolved without treatment.
Several weeks later, numbness developed in a bandlike distribution around her trunk. During the following week, the numbness spread to her upper abdomen, creating what many patients describe as abdominal numbness.
She became unable to sit up from a lying position without using her arms and also developed abdominal distention.
Her symptoms continued to progress. Tingling and burning sensations developed in the third, fourth, and fifth fingers of her left hand and the fourth and fifth fingers of her right hand.
The numbness eventually extended into the genital region and was accompanied by urinary incontinence.
Although uncommon, this combination of sensory changes, abdominal wall weakness, and bladder dysfunction can occur when Lyme disease affects multiple spinal nerve roots.
A Rash That Was Mistaken for an Insect Bite
The woman lived in a wooded area of Connecticut, where Lyme disease is endemic.
Approximately three months before hospitalization, she noticed a small, uniformly red, painless, non-itchy rash consistent with erythema migrans, the characteristic skin lesion of early Lyme disease.
She believed the rash was caused by an insect bite, and it resolved without treatment.
This seemingly minor event later proved to be one of the most important diagnostic clues. An untreated erythema migrans rash can precede neurologic Lyme disease by weeks or months.
For more on why early skin findings are frequently overlooked, see the importance of obtaining a second opinion after a tick bite or rash.
Why Lyme Radiculopathy Became the Leading Diagnosis
The patient also had hypertension, hypothyroidism, previous tibial and fibular fractures, lumbar spine surgery, and poorly controlled diabetes.
Her blood glucose level was 291 mg/dL, and her glycated hemoglobin measured 11.8%, suggesting diabetes could have been considered as an alternative explanation for some of her neurologic symptoms.
Despite these competing possibilities, her recent erythema migrans rash, residence in a Lyme-endemic area, and pattern of progressive neurologic symptoms strongly suggested Lyme neuroborreliosis.
Reda and colleagues concluded that her recent rash and associated Lyme disease risk factors made Lyme radiculopathy the leading diagnosis.
A Lyme disease Western blot subsequently demonstrated positive IgG reactivity to 9 of 10 diagnostic bands, strongly supporting the diagnosis.
Why a Spinal Tap Was Not Required to Diagnose Lyme Disease
The patient did not require a spinal tap to establish the diagnosis.
As Reda and colleagues explained, patients with compatible neurologic findings and positive Lyme serology often meet the clinical criteria for Lyme neuroborreliosis without requiring cerebrospinal fluid confirmation.
Nevertheless, a lumbar puncture was performed as part of her evaluation.
The authors noted that direct detection of Borrelia burgdorferi by cerebrospinal fluid PCR is rarely successful.
Because CSF PCR testing has poor sensitivity, a negative result does not exclude Lyme neuroborreliosis and should not override compatible clinical findings.
Final Diagnosis: Lyme Meningoradiculitis
Based on the patient’s clinical presentation and Lyme serology, the final diagnosis was Lyme meningoradiculitis, a form of Lyme neuroborreliosis involving inflammation of the meninges and spinal nerve roots.
She received a three-week course of intravenous ceftriaxone.
Her pain gradually improved during the following month, but neurologic recovery was slower.
Four months after treatment began, strength in her abdominal wall had improved enough that she could contract her rectus abdominis muscles while standing. However, she still had difficulty sitting up from a lying position.
Weakness involving her left foot also improved, although she continued to have difficulty walking on her heel.
This pattern illustrates an important feature of Lyme neuroborreliosis: although antibiotics eliminate the infection in many patients, recovery of injured nerves may continue for months after treatment ends.
Lessons from This Case
This case reminds clinicians that Lyme disease is not always accompanied by fever, arthritis, or a classic expanding rash at the time neurologic symptoms develop.
Instead, patients may present weeks or months after an untreated erythema migrans lesion with numbness, tingling, radicular pain, muscle weakness, abdominal wall dysfunction, or bladder symptoms.
Because these manifestations resemble disorders involving the spine, peripheral nerves, or brain, Lyme disease can easily be overlooked unless clinicians obtain a careful exposure history and consider tick-borne illness in the differential diagnosis.
Current reviews of Lyme neuroborreliosis emphasize that diagnosis depends on integrating the patient’s history, neurologic examination, epidemiologic exposure, and laboratory findings rather than relying on a single test. Early recognition remains important because delayed diagnosis may prolong neurologic disability.
Clinical Perspective
Neurologic Lyme disease often presents differently than patients and physicians expect.
Over the years, I have evaluated patients whose first symptoms included radicular pain, abdominal numbness, burning sensations, weakness, or autonomic dysfunction rather than arthritis or facial palsy.
Cases like this reinforce the importance of considering Lyme disease whenever progressive neurologic symptoms develop in someone with possible tick exposure, even when imaging studies or cerebrospinal fluid testing are nondiagnostic.
Although many patients improve with appropriate antibiotic therapy, recovery of nerve function may take considerably longer than eradication of the infection itself.
Clinical Takeaway
Lyme disease can produce atypical neurologic symptoms including abdominal wall weakness, numbness, paresthesia, urinary dysfunction, and radicular pain.
Recognition of these less familiar presentations may shorten the time to diagnosis and treatment, improving the likelihood of neurologic recovery.
Frequently Asked Questions
Can Lyme disease cause abdominal numbness?
Yes. Lyme neuroborreliosis may inflame spinal nerve roots supplying the trunk, producing abdominal numbness, bandlike pain, or weakness of the abdominal wall.
Can Lyme disease cause urinary problems?
Yes. In uncommon cases, inflammation affecting spinal nerve roots can lead to urinary urgency, retention, or incontinence.
Is a spinal tap always necessary to diagnose Lyme neuroborreliosis?
No. Patients with compatible neurologic symptoms, positive Lyme serology, and characteristic clinical findings may not require cerebrospinal fluid testing to establish the diagnosis. A negative CSF PCR does not exclude Lyme neuroborreliosis because the test has poor sensitivity.
How long does recovery from Lyme neuroborreliosis take?
Many patients improve after appropriate antibiotic treatment, but recovery of damaged nerves may continue for several months depending on the severity and duration of neurologic involvement.
Can Lyme disease mimic other neurologic disorders?
Yes. Lyme neuroborreliosis may resemble lumbar radiculopathy, diabetic neuropathy, multiple sclerosis, peripheral nerve disorders, or other neurologic conditions, making careful clinical evaluation essential.
Related Articles
- Neurologic Lyme Disease Presenting as Abdominal Pain
- Neurologic Lyme Disease: Symptoms and Treatment
- Atypical Findings in Lyme Disease Make Diagnosis Difficult
- The Importance of Follow-up in Lyme Disease
- Lyme Radiculopathy: When Nerve Root Pain Signals Infection
References
- Reda HM, Harvey HB, Venna N, Branda JA. Case 34-2018: A 58-Year-Old Woman with Paresthesia and Weakness of the Left Foot and Abdominal Wall. N Engl J Med. 2018;379(19):1862-1868.
- Koedel U, Fingerle V, Pfister HW. Lyme neuroborreliosis—epidemiology, diagnosis and management. Nat Rev Neurol. 2015;11(8):446-456
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
I experienced this for 3 weeks about 2 yrs ago. It felt like novacane on entire right lower quadrant down to right hip. It makes me sad to this day local Drs treat lyme patients so poorly. After a decade of lyme/babesia and co many of us cant afford to see lyme specialists any longer. I really wish there was some way to educate mainstream about things like this illness. Being treated poorly on top of this illness feels like a slap in the face. The mental abuse we go through from mainstream medical is the worst part of this illness. Very sad
I was diagnosed with Lyme myositis 7 years ago by a neurologist. One of the test she ordered was a muscle biopsy. The tissue samples were sent to a lab that never examined muscle biopsy tissue samples for evidence of borrelia burgdorferi and my patient history did not go along with the samples. The lab did not examine them for borrelia. Instead they wrote a separate report with this sentence: This suggests a possibility of polymyositis. I was sent to Rheumatology next. There I was given immunosuppressants:prednisone and others. After a few months of no improvement I was told by the rheumatologist that Lyme disease does not exist in our state and that I had polymyositis. He changed the diagnosis without any further testing to polymyositis. After over a year with worsening symptoms, he left me with these words: You have a serious condition but I cannot help you I’m sending you to the university where the lab is located( on the far other side of our state).
I also see complicated cases. I refer my complicated cases to rheumatology as needed for them to weigh in on the case. I try not to dismiss Lyme disease so readily. I would advise my patients to look a second time at Lyme disease while asking a second rheumatologist to weigh in. BTW there is Lyme disease in Wisconsin as you already know. Call my office at 914 666 4665 if you have any questions.
I am having traveling, Burning, radiating nerve pain, And tingling and brain fog. I had fatigue symptoms four years ago and tested positive for Erlichiosis and anaplasmosis however it was “borderline” so they would not treat me.
I went to the E.R. two years ago and again tested “borderline”. I asked the e.r. Doctor to prescribe doxycycline. He did and I felt so much better within days and like a new person three weeks later… until 6 weeks ago. Went in to see infectious disease specialist, who ordered a full tick panel. All other diseases were negative and Lyme came back “low” ( .91 I think). I was not treated. He wants me to repeat the test now. Also saw neurologist who ordered more blood work. An ANA test came back “slightly elevated” indicating RA or Lupus. Following up with neurologist next Tuesday. Hope he listens. Symptoms are uncomfortable.
I have patients that have gone down that path. Most doctors I have seen exhaustively look follow every lead but are reluctant to look at Lyme disease again unless the tests are positive.
My daughter was healthy and energetic. She was bitten by a tick twice and both times I was refused doxy. Her only symptom was long standing slight swelling of the lymph nodes near the bite (back of neck) now she is usually tired a lot, has very poor posture and can only eat very small meals and never breakfast. Sensitive to load noises and light. Some anxiety and depression with zero stress tolerance. I ordered blood tests and her CBC shows Low RDW and high triglycerides. Normal folate and B12. Low vitamin D. Elevated kryptopyrrole urine test at 36+ which may be an inherited condition. Any suggestions? It’s been a few years. Thank you.
I find that individuals with Lyme disease in my practice typically have a broad range of other symptoms that help make the diagnosis. Your daughter appears to have other findings that might be helpful in making a diagnosis. I advise my patients to include an evaluation by a doctor experienced in treating Lyme disease in addition to other doctors.
Just Diagnosed with Lyme after 5 years of being told I have MS by 5 doctors (2 of them being “MS specialists”). I can’t feel my skin from bra down. Feet feel like I have duct tape on the bottom and tingling and walking on nails feeling all at the same time. I’m about to start treatment with BB-1 but terrified that this horrible flare isn’t a flare but is permanent. What else can be done to stop the flare? – taking turmeric, E, D, aloe Vera, B6, B12, folate, and C’s. Also currently on a nasal spray for strep and a binder.
Lyme disease and multiple sclerosis can look alike. I often find antibiotics helpful in my patients even if they have been ill for 5 years. You did not mention whether you tried antibiotics.
I’ ve been having constant muscle twitching that comes and goes all over for 8 years now. On top of that i also have back pain for 9 years. I was diagnosed with hernia and spinal stenosis. I also have intermminent aches and weird sensation in legs for years now. For the last 5 months i have patella clicking, nerve pain in the sole of one foot and slight paraesthesias in the same foot. I was diagnozed for tarsal tunnel syndrome but this doesn’t explain the tingling in legs and constant muscle twitching for years. Could it be Lyme desease? Ι live in Greece? Where could i get tested and treatment? Is Western blot test relaible as a first step? Thank you in advance!
I would typically include a doctor with expertise in Lyme disease. I would also keep working with other specialists for other illnesses. I have had patients who have more than one illness. I do not know enough about the region to help you.
Daughter permanently disabled [ 21 years from age 7 and still infected ] and looking as though son will be also. [ 20 years from age 5 ] Husband – almost died, but the doctor called him a Lyme lunatic. Me – I almost didn’t make it either. 250,00.00 given to the the medical ‘industry ‘ and counting.
My father started experiencing foot numbness and severe fatigue that no one could explain. He received the covid vaccine and the numbness moved into his legs, saddle and trunk region, and now to his hands. Severe calf cramping and he can barely walk. Pushed for a Lyme test which was positive active infection. 21 days of doxy. Question I have is will the numbness stop progressing and is this a typical presentation? Could the calf pain be bartonella? I plan on pushing for IV antibiotics
It sounds as if a tick-borne illness has not been adequately addressed. You might find working with a doctor experienced in treating chronic manifestations of Lyme disease.
I’ve read that the majority of Morgellons sufferers test positive for Lyme disease. Are you familiar with this? And will treatment for Lyme disease lesson the symptoms of this mysterious, unbelievable disease that only a hand full of doctors will acknowledge while the remainder of them including the CDC say it’s a mental illness and those who suffer from this horrific disease are delusional as the number of patients steadily increase all over the world except for island. Suggesting all of these patients from everywhere all over the world are some how imaging all of the same unimaginable things while suicides are prevalent and lives are consumed. A lot of which have been committed to mental hospitals or referred to psychiatrists for delusions and psychosis. While each patient either has or or will lose the quality of their life. Through isolation, loss of jobs, no infer able to work bc the disease is all consuming. It’s very common for some or all family members and friends not believing you bc a lot of it isn’t possible or has never happened to a human. Yet as alone, terrified and abandoned as they are desperately seeking help when they’re dismissed as crazy and delusional needing help in support ever, yfriends and health professionals
OR…IT HAS NEVER HAPPENED TO THEM PERSONALLY. Meaning..unless it directly affects them…most people do not care. If they’ve been vaccinated… unfortunately they will find out sooner than later
Chronic Lyme, Bart, Babesia and other coinfections, finally diagnosed after getting no where and have probably had this since my teens, just turned 60. Is there any correlation with bartonella and recurrent inguinal hernias? I’ve had 2 repairs on my right side and now seems I have 1 on the left side?
I have not seen any correlation with a tick borne illnesses and inguinal hernias. I have seen patients in my practice who realize they have Lyme disease while being evaluated for another illness.
I had burning shoulders…especially around the shoulder area where I had the vaccine booster. Also a badly swollen knee, where I had reconstructive ACL surgery 20 years ago. I went to one of the leading university hospitals in the country and was diagnosed by a Rheumatologist with a garbage label of RA. More respectively, Inflammatory Arthritis with a form of Myalgia. This diagnosis was given to me before they ordered 12 vials of blood. A huge red flag, in my book. I was prescribed a lifelong treatment of a low dose chemo for the rest of my life. The side effects alone can be fatal and might be worse than the illness. Flash forward 6 weeks later to today: I got in with an infectious disease doctor who is an out of the box thinker. He looked at my knee and he wanted to know when I got bit by a tick. He also looked at all 5 version of unremarkable blood work that was taken by prior Rheumatologists and two things stuck out: elevated ANA count (which often gets confused with Lupus, RA or Hoshimotos). Infectious disease doctor ordered a proper Lyme test with Western Blot and ELISA and several bands came back for borrelia burgdefori but the CDC would not approve a positive result for Lyme. Only some markers for Lyme and test result as Indeterminate. What does that even mean!? There is hope: I am three weeks of doxycycline and the knee swelling and pain improved 4 days later. I still have several months left of antibiotics. Best advice is what some of the Doctors on this thread recommended: find an infectious disease doctor (Lyme specialist) or better yet: functional medicine to get to the why or cause before you make a garbage diagnosis that can ruin your life. Hope this helps.
My mom has had Lyme disease for about 2 years and experiences paresthesia everywhere with some days having it more than others but it never goes away. She’s been on treatment and has 2 more weeks to go because they found she also had brucellosis and bartonella. She’s done lab test and they show she doesn’t have damage in her nerves. My question is, is this permanent or will it go away once she finishes her treatment?
Lyme steals a life long before it ends it.