CIDP and Lyme Disease: Can Chronic Inflammatory Demyelinating Polyneuropathy Be Misdiagnosed?
CIDP and Lyme disease may share overlapping neurologic symptoms
Negative Lyme tests do not always exclude infection
Delayed diagnosis may prolong neurologic disability
The relationship between CIDP and Lyme disease remains controversial, particularly when patients present with progressive weakness, paresthesias, and evidence of demyelination. Some patients initially diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) may later be found to have evidence suggesting an infectious trigger or alternative explanation.
A published case highlights how diagnostic uncertainty can complicate care when neurologic symptoms persist despite standard treatment approaches.
This case raises a question patients often ask: can chronic inflammatory demyelinating polyneuropathy and Lyme disease appear similar enough to delay diagnosis?
A patient diagnosed with CIDP improved after antibiotic treatment
The woman presented with asthenia, weakness, and diffuse paresthesias. Electromyography showed mild demyelination. Lyme disease was reportedly ruled out based on negative serum and cerebrospinal fluid serologic testing.
Intravenous immunoglobulin treatment was performed eight times for CIDP with partial response followed by relapse.
Lyme disease was diagnosed 10 months after symptom onset when serum polymerase chain reaction analysis disclosed the presence of Borrelia (100 copies/mL).
The woman was then treated successfully with six weeks of doxycycline and hydroxychloroquine and experienced what the authors described as “a dramatic clinical improvement” with disappearance of neurologic signs, according to Perronne.
Why CIDP and Lyme disease can be difficult to distinguish
Chronic inflammatory demyelinating polyneuropathy is a neurologic disorder involving inflammation of nerve roots and peripheral nerves with destruction of the myelin sheath surrounding nerves. Symptoms often include progressive weakness, numbness, gait difficulty, and impaired sensory function.
However, Lyme disease can also involve peripheral nerves and may present with sensory changes, weakness, neuropathic pain, autonomic symptoms, and cognitive complaints. Diagnostic overlap may contribute to confusion when patients fail standard therapies or experience relapse.
Clinicians may also consider broader differential diagnoses when evaluating demyelinating neuropathies, especially when symptoms evolve atypically or standard treatment produces incomplete responses.
Relapsing symptoms after infections or immune stressors may further complicate diagnosis, particularly when patients experience cycles of improvement and worsening over time.
Can Lyme testing miss neurologic disease?
The authors advised against automatically ruling out Lyme disease solely because of negative serologic findings.
“In our opinion, Lyme formal serology negativity is insufficient to rule out early (erythema migrans) and late chronic Lyme disease diagnosis.”
False-negative testing, timing of antibody production, immune variability, and limitations in available diagnostics continue to complicate assessment in selected cases.
Patients with neurologic symptoms may also benefit from broader evaluation strategies that integrate history, examination findings, exposure risk, and treatment response rather than relying on a single laboratory result.
Frequently Asked Questions
Can CIDP be misdiagnosed as Lyme disease?
Symptoms may overlap. Weakness, numbness, paresthesias, gait problems, and neuropathy can occur in both conditions, making careful evaluation important.
Can Lyme disease cause demyelination?
Some reports describe demyelinating findings in Lyme disease, though the relationship remains debated and may vary between patients.
What if Lyme tests are negative but symptoms continue?
Persistent symptoms sometimes require reassessment of the diagnosis, repeat clinical evaluation, and consideration of alternative explanations or coexisting conditions.
What can trigger relapse of CIDP?
Relapses may occur after infections, immune activation, medication changes, or incomplete treatment response. Persistent or recurrent symptoms warrant reassessment of the diagnosis and contributing factors.
Is CIDP curable?
Some patients improve substantially with treatment, while others experience relapsing symptoms that require long-term management.
Clinical Takeaway
The overlap between CIDP and Lyme disease illustrates why persistent neurologic symptoms can remain diagnostically challenging. When patients fail expected therapies or relapse repeatedly, reconsidering the diagnosis may be appropriate.
Neurologic illness does not always fit neatly into a single diagnostic category, especially when testing and symptoms do not align.
Related Articles
These related articles explore neurologic complications, persistent symptoms, recovery pathways, and mechanisms that may contribute to prolonged illness after Lyme disease.
Post-treatment Lyme disease syndrome
Recovery from Lyme disease
Persistent Lyme disease mechanisms
Lyme test accuracy
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. Chronic inflammatory demyelinating polyneuropathy information.
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.