The Herxheimer reaction, also referred to as a Jarisch-Herxheimer reaction, is "a transient clinical phenomenon that occurs in patients infected by spirochetes who undergo antibiotic treatment."¹ It was first described in patients with syphilis but has also been associated with other spirochetal infections including leptospirosis, Lyme disease, and relapsing fever. The reaction is associated with the onset of new symptoms or a worsening of existing symptoms in patients receiving antibiotic treatment.
Some patients with Lyme carditis may require a pacemaker for conduction abnormalities. In a recent study, investigators described the successful removal of pacemakers in two patients with Lyme carditis who recovered normal atrioventricular node conduction.
Doctors typically look for Bell’s palsy or erythema migrans rash when diagnosing Lyme disease. However, Baker and colleagues described a 10-year-old boy with Lyme disease with neck pain without Bell’s palsy or an erythema migrans rash. 
Lyme disease can be a challenging illness for both physicians and their patients. In an article entitled “Knowing the entire story - a focus group study on patient experiences with chronic Lyme-associated symptoms (chronic Lyme disease),” Baarsma et al. share various perspectives of self-identified chronic Lyme disease patients from the Dutch Lyme community.
In their article “A Tick-borne Cause of Hyponatremia: SIADH Due to Lyme Meningitis,” Windpessl and colleagues describe a patient who was initially treated for sudden onset of shoulder pain associated with hyponatremia but later diagnosed with Lyme meningitis. 
Lyme Arthritis and Rheumatoid Arthritis can greatly impair a person’s quality of life. A recent study examines survey results from 90 patients to assess the levels of impairment for patients with both these conditions.
An erythema migrans (EM) rash, sometimes referred to as a bull's eye rash, has been considered the signature rash for Lyme disease, leading to a definitive diagnosis. Yet only 1 in 4 erythema migrans rashes present with a bull’s eye appearance.
In a review entitled “Lyme Disease: Emergency Department Considerations,” Applegren et al. recommend using a one-time, single dose of doxycycline for the prophylactic treatment of a tick bite,  despite the fact that there has been only one study exploring the effectiveness of such a limited dosage. The article also neglects to mention that there are doctors who take a different approach and advise against a one-time, single dose. 
In their case report “Fatal Babesiosis in an Immunocompetent Patient,” Selig and colleagues describe a 48-year-old man who died within days of being admitted to the hospital from babesiosis and yet, he didn’t have any significant risk factors for severe presentation of the illness. 
In their case report, Gandhi and colleagues, describe an immunocompetent patient who developed acute-onset, progressive encephalopathy due to an infection with Borrelia miyamotoi.