Bannwarth Syndrome and Weight Loss: An Atypical Case of Neurologic Lyme Disease
SEVERE BACK PAIN WITH NO CLEAR CAUSE?
LYME DISEASE MAY PRESENT AS BANNWARTH SYNDROME
“The pain was severe—and nothing explained it.”
In some patients, Lyme disease presents not with fatigue or joint pain—but with intense nerve pain, weakness, and unusual systemic symptoms.
Quick Answer: Bannwarth syndrome is a neurologic form of Lyme disease characterized by severe radicular pain, neuropathy, and sometimes facial nerve palsy.
Clinical Insight: Atypical features such as weight loss or liver abnormalities can delay recognition of neurologic Lyme disease.
Bannwarth syndrome is more commonly described in Europe, but similar cases are increasingly recognized in the United States. :contentReference[oaicite:0]{index=0}
An unusual presentation of Bannwarth syndrome
A 60-year-old man initially presented with unexplained weight loss of approximately 25 pounds and abnormal liver function tests.
Over several weeks, he developed progressive back pain and neurologic symptoms, including:
- Arm and leg weakness
- Numbness in the hands
- Facial droop progressing to complete facial palsy
Severe central back pain persisted and required aggressive pain management.
Neurologic findings
Electrodiagnostic testing showed findings consistent with polyradiculopathy.
A spinal tap revealed lymphocytic pleocytosis and elevated protein levels, consistent with inflammatory meningoradiculitis seen in neurologic Lyme disease.
Laboratory evaluation and diagnostic complexity
Lyme serologic testing was positive by IgG Western blot.
Because of abnormal liver tests, clinicians considered co-infections such as anaplasmosis, but testing was negative.
Babesia serology was positive, though no parasites were detected on blood smear.
This combination of findings complicated the diagnostic picture.
Treatment and recovery
The patient was treated with four weeks of intravenous ceftriaxone.
At follow-up, facial paralysis, pain, and neurologic deficits resolved.
His weight and liver function returned to baseline.
Why this case matters
Bannwarth syndrome is characterized by painful radiculopathy and neurologic deficits, but it is often under-recognized in the United States.
In this case, atypical features—including weight loss and liver dysfunction—delayed diagnosis.
Patients with similar symptoms may initially be evaluated for spinal disorders, autoimmune disease, or other infections.
In endemic areas, Lyme disease should remain in the differential diagnosis when patients present with severe radicular pain and neurologic symptoms.
Clinical perspective
Bannwarth syndrome should be considered in patients with:
- Severe radicular pain
- Peripheral neuropathy
- Motor weakness
- Facial nerve palsy
Even when atypical symptoms—such as weight loss or liver abnormalities—are present.
Recognition of this pattern can lead to timely treatment and improved outcomes.
Clinical takeaway
Lyme disease can present with severe neurologic pain and atypical systemic symptoms.
Bannwarth syndrome, though often associated with Europe, is increasingly recognized in the United States.
Early recognition is critical to prevent prolonged neurologic complications.
Frequently Asked Questions
What is Bannwarth syndrome?
A neurologic form of Lyme disease characterized by severe nerve root pain, neuropathy, and sometimes facial nerve palsy.
Is Bannwarth syndrome seen in the United States?
Yes. Although more commonly reported in Europe, cases are increasingly recognized in the U.S.
Can Lyme disease cause severe back pain?
Yes. Lyme radiculopathy can cause intense nerve root pain in the back and limbs.
Can Lyme disease cause weight loss?
Yes. Although uncommon, systemic symptoms such as weight loss may occur in atypical cases.
Related Reading
References
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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
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.