CIDP and Lyme Disease: Case Resolved with Antibiotic Treatment
Lyme disease can mimic or trigger neurological conditions that do not respond to standard therapies. In some cases, treating the underlying infection may lead to resolution of symptoms previously attributed to autoimmune disease.
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neurological disorder involving inflammation of nerve roots and peripheral nerves, with destruction of the protective myelin sheath. It causes progressive weakness and impaired sensory function in the legs and arms.
This case demonstrates how CIDP can be associated with Lyme disease—and how antibiotic treatment resolved what immunoglobulin therapy could not.
The Case: CIDP Misdiagnosed for 10 Months
A woman presented with asthenia, weakness, and diffuse paresthesias. Electromyography showed mild demyelination. Lyme disease was initially ruled out based on negative serum and cerebrospinal fluid serologic tests.
She received intravenous immunoglobulin treatment 8 times for CIDP with partial response and relapse each time.
Lyme Disease Diagnosed After Serology Failed
Lyme disease was finally diagnosed 10 months after symptom onset—not through standard serology, but when a serum polymerase chain reaction (PCR) analysis detected the presence of Borrelia.
This case highlights an important limitation of testing: negative Lyme serologic tests do not always exclude infection. Standard two-tier testing failed to detect this patient’s illness.
Antibiotics Resolved Persistent Neurologic Symptoms
The patient was treated with 6 weeks of doxycycline and hydroxychloroquine. She experienced marked clinical improvement with resolution of neurologic findings, according to Perronne.
After multiple courses of immunoglobulin therapy produced only temporary improvement, antibiotic treatment targeting the underlying infection led to sustained recovery.
Why This Case Matters
- CIDP may be associated with Lyme disease, even when standard serologic tests are negative
- PCR testing detected infection that serology missed
- Immunoglobulin therapy alone did not address the underlying cause
- Antibiotic treatment led to resolution of neurologic symptoms
- Negative serology should not automatically exclude Lyme disease in compatible cases
The authors noted that negative Lyme serology may be insufficient to rule out infection in some patients.
For a broader overview, see Lyme disease neuropathy.
Frequently Asked Questions
Can Lyme disease cause CIDP?
Yes. This case report describes CIDP associated with Lyme disease, with resolution after antibiotic treatment.
Can CIDP improve with antibiotics?
If CIDP is related to an underlying infection such as Lyme disease, treating the infection may lead to improvement or resolution.
Can Lyme disease be missed on standard blood tests?
Yes. In this case, both serum and cerebrospinal fluid serologic tests were negative. Diagnosis was made using PCR testing.
What is CIDP?
Chronic inflammatory demyelinating polyneuropathy is a neurological disorder involving inflammation and damage to the myelin sheath of peripheral nerves, leading to weakness and sensory symptoms.
How is CIDP different from other Lyme-related neuropathies?
CIDP involves demyelination, while other Lyme neuropathies may affect small nerve fibers and present differently.
References
- Perronne C, Lacout A, Marcy PY, El Hajjam M. Errancy on Lyme Diagnosis. Am J Med. 2017;130(5):e219.
- Cameron DJ. Consequences of treatment delay in Lyme disease. J Eval Clin Pract. 2007;13(3):470-472.
- National Center for Advancing Translational Sciences. rarediseases.info.nih.gov.
Related Reading
- Lyme Disease Neuropathy: Symptoms and What Causes It
- Femoral Neuropathy and Lyme Disease
- Autonomic Dysfunction, Small Fiber Neuropathy and Lyme Disease
- Small Fiber Neuropathy in Lyme Disease and COVID-19
- Full Body Numbness and Tingling Due to Lyme Disease
- Autonomic Dysfunction and Lyme Disease
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 had a positive IGG western blot test in May 2020 after receiving multiple ticks bites in the Dordogne region of France over a period of several years. No rash was ever detected.
Symptoms elevated in the last 3 months seem to be an exact replica of those described in this article, however the doctors in Norway, where my my MRI and lumbar puncture were performed expressed that the mild demyelination that showed was indicative of a “ normal” result for my age (55). Even though borrelia antibodies were found in the spinal fluid it was assessed as being negative for borreliosis. It seems very difficult to confer with a LLMD in Europe and they do not exist in Scandinavia. I am currently still on a two month waiting list with a LLMD in the Netherlands. It would be so helpful to speak with someone who has expertise in this field.
How are you doing now Lisa? Were you able to locate a reputable physician(s) interested in considering your case of CIDP related to Lyme borreliosis? Please be careful regarding so called LLMD’s. They are often self-proclaimed and are prone to self-promotion through dubious methods. Be particularly wary of doctors who demand payment, some in cash, upfront. That’s a clear indicator in the US at least, that the physician probably uses treatment(s) that are considered “alternative” at best and most importantly, have not been subjected to scientific scrutiny. I pray you are doing better.