Can Lyme Disease Cause Weight Loss? Bannwarth Syndrome Case
Lyme disease may rarely present with unexplained weight loss
Bannwarth syndrome can cause painful radiculopathy and facial palsy
Neurologic Lyme disease may be overlooked in atypical cases
Lyme disease may occasionally present with unexpected symptoms such as significant weight loss, liver dysfunction, neuropathy, or severe radicular pain.1
One atypical neurologic presentation is Bannwarth syndrome, a form of Lyme neuroborreliosis associated with painful radiculopathy, weakness, sensory symptoms, and cranial nerve involvement.
For a broader overview of neurologic complications, visit our Neurologic Lyme Disease hub.
Bannwarth Syndrome and Weight Loss
Bannwarth syndrome is more commonly reported in Europe. However, Mayo Clinic physicians previously described several patients living in Minnesota and Wisconsin with neuroinvasive Lyme disease presenting with peripheral neuropathy.
In 2019, Diaz and Wesley described a 60-year-old man from the United States with a variant form of Bannwarth syndrome.1
The patient initially presented with elevated liver function tests and unintentional weight loss of approximately 25 pounds.1
Over a 3-week period, he developed progressive back pain along with arm and leg weakness, numbness in his hands, and a right facial droop. Shortly after hospitalization, he developed complete facial palsy.1
Diaz wrote that “throughout this time, severe central back pain persisted requiring neuropathic pain agents and opiates for adequate pain-control.”1
Neurologic Findings Suggested Lyme Radiculopathy
EMG and nerve conduction studies demonstrated prolonged distal latencies and slowed conduction velocity consistent with polyradiculopathy.1
Spinal fluid analysis revealed lymphocytic pleocytosis and elevated protein levels consistent with neuroinflammation.1
Lyme Western blot testing of both serum and spinal fluid was positive for IgG antibodies.1
A CSF:serum antibody index assay was not performed.
For more on Lyme radiculopathy and neuropathy, visit our Femoral Neuropathy in Lyme Disease article.
Co-Infections and Liver Dysfunction
Anaplasmosis was considered as a possible explanation for the patient’s elevated liver function tests, but testing was negative.1
Babesia serology was positive, although no parasites were identified on blood smear.1
This case highlights how Lyme disease and possible co-infections may present with overlapping neurologic and systemic symptoms.
For more on tick-borne co-infections, visit our Lyme Coinfections hub.
Improvement After Treatment
The patient was diagnosed with a variant form of Bannwarth syndrome and treated successfully with 4 weeks of intravenous ceftriaxone.1
At 2-month follow-up, facial paralysis, pain, motor deficits, and sensory symptoms had resolved.
The patient also returned to baseline weight and liver function levels.1
Diaz concluded that “our case demonstrates the importance of consideration of Bannwarth syndrome in the differential of meningoradiculitis, even in the setting of atypical features such as liver dysfunction and weight loss.”1
Why Weight Loss in Lyme Disease May Be Missed
Weight loss is not typically considered one of the classic Lyme disease symptoms.
However, severe neurologic Lyme disease, chronic inflammation, pain, autonomic dysfunction, gastrointestinal symptoms, or co-infections may contribute to unintended weight loss in some patients.
Patients with atypical neurologic symptoms may experience delayed diagnosis—especially when symptoms resemble spine disease, neuropathy, autoimmune illness, or other neurologic disorders.
For more on difficult-to-recognize cases, visit our Lyme Disease Misdiagnosis article.
Frequently Asked Questions
Can Lyme disease cause weight loss?
Yes. Some patients with Lyme disease—particularly neurologic Lyme disease or co-infections—may experience unintended weight loss.1
What is Bannwarth syndrome?
Bannwarth syndrome is a form of neurologic Lyme disease associated with painful radiculopathy, weakness, sensory symptoms, and facial palsy.1
Can Lyme disease cause facial palsy?
Yes. Facial nerve palsy is a recognized neurologic manifestation of Lyme disease.
Can Lyme disease cause neuropathy?
Neurologic Lyme disease may cause peripheral neuropathy, radiculopathy, numbness, weakness, or paresthesia.
Can Lyme disease affect liver function tests?
Some tick-borne infections and inflammatory responses may contribute to elevated liver function tests in certain patients.1
Can neurologic Lyme disease improve with treatment?
Some patients improve substantially with antibiotic treatment, although delayed diagnosis may prolong recovery.
Clinical Takeaway
Lyme disease may occasionally present with atypical neurologic symptoms including severe radicular pain, neuropathy, facial palsy, liver dysfunction, and significant weight loss.
Bannwarth syndrome should be considered in patients with painful polyradiculopathy and compatible Lyme exposure risk—even when symptoms initially appear atypical.
Unexplained weight loss and neurologic symptoms may represent an underrecognized presentation of neuroinvasive Lyme disease.
Related Articles
These related articles explore neurologic Lyme disease, radiculopathy, delayed diagnosis, autonomic dysfunction, and atypical Lyme presentations.
Neurologic Lyme Disease Presenting as Abdominal Pain
Six Cases of Neuroinvasive Lyme Disease
Delayed Lyme Disease Diagnosis
Autonomic Dysfunction in Lyme Disease
Post-Treatment Lyme Disease Syndrome
References
- Diaz MM, Wesley SF. Meningoradiculitis and transaminitis from neuroborreliosis: A case of variant Bannwarth syndrome. Clin Neurol Neurosurg. 2019;186:105532.
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
Dr Cameron,
have you ever seen a case of Kluver Bucy from Lyme or any of the coinfections? Hyperphagia and visual agnosia as dominant. I am confident KBS describes the condition because I got prosopagnosia from antibiotics. Many symptoms vary in intensity but it’s never as before onset of POTS/Hashimoto/SFN
there was nothing on MRI and spinal tap was normal.
Although both were done 15 years after the onset.
The symptoms started along with Hashimoto, POTS, and numbness of the left face.15 years later I found out I also have Sjogrens which was presenting as POTS but now also sicca (15+ yrs no sicca but only mild parotid swelling from start of disease)
I read KBS might come from tirgeminal nerve path virus entering the head?
-But I am negative to HSV1/2 even.
mycoplasma negative
chlamydia IgG pos,
Lyme LTT high positive, after it become negative not much help in KBS
my KBS symptoms do respond to essential oils antibiotics and to IVIG, but never fully. Overall 3+ years of various antibiotics just made me worse and tons of herxing but my autoimmunity grew stronger it seems.
I wonder if it’s gut related, there seems like low grade inflammation of my head but especially areas linked to KBS symptoms.
Thank you
Kluver Bucy syndrome is a rare behavioral impairment characterized by inappropriate sexual behaviors and mouthing of objects. Other signs and symptoms include a diminished ability to visually recognize objects, loss of normal fear and anger responses, memory loss, distractibility, seizures, and dementia according to https://rarediseases.info.nih.gov/diseases/6840/kluver-bucy-syndrome I have not seen KBS.
I was recently diagnosed with Bannwarth syndrome after suffering for nearly 3 years with nerve issues. Saw lots of doctors before finally a very posity test. (3 IGM, 8 IGG). I completed two rounds of doxy and 30 days of ceftriaxon IV.
After the neurologists, one said Bannwarth, who said your nerves are damaged and live with it. I’m already taking hydrocodone daily, with propanalol for tremors.
I’m having a real hard time accepting ” live with it”. Do you know if anything that can treat this horrible syndrome?
Dr. Cameron, I have a friend who started showing signs of lyme disease a year ago. I told her to get tested for it. Her provider refused and told her she didn’t need to be tested for it. After a year of her declining, they finally did a test. IGM positive Lyme total AB EIA positive. The provider proceeded to tell her that she does not have Lyme and was “only exposed to it”. She started having visual disturbances that she described as a rainbow. She went to a neurologist, they told her migraines. Started her on topamax. She started having severe swelling in her legs, so they put her on a thiazide to help pull the fluid off her legs and feet. She has continued to decline and is now on the verge of giving up. She went from 170 pounds to 95 pounds in a span of 6 months. Her PCP continues to tell her that there is nothing wrong with her. She eats and has been trying to gain weight. She stopped the topamax months ago bc she had lost so much, but continues to go down in weight. She now has neuropathy, sleeps all the time, she has a hard time walking and has to hold on to something or she can’t get around. If you have any suggestions, or would be willing to see her. I strongly believe that she has a coinfection present. The PCP’s that don’t understand Lyme disease or the risks that come with it. I have a very good friend who came to you, and that is why I am messaging you. Thank you so much for your time.
I am still seeing patients with similar presentations to your friend. I wish the tests were more reliable. You can direct your question to my office.