When Numbness Spreads Everywhere: A Case of Lyme Neuropathy

A 25-year-old woman developed numbness and tingling throughout her torso, which later spread to her entire body. She presented to a neurology clinic with complaints that had been ongoing for 4 weeks.

She did not recall a rash or tick bite and had not recently travelled. She did not exhibit any of the typical symptoms seen with Lyme disease — no arthralgia, fever, rash, or regional lymphadenopathy. Instead, she exhibited decreased reflexes, numbness, and tingling, particularly near the hypogastric region, making her presentation distinct from the classical picture.

How the Numbness and Tingling Progressed

The numbness and tingling began on the right side of her stomach and radiated to her back before spreading to her entire body. The tingling was not associated with burning or pins-and-needles sensation, according to the authors.

She was prescribed steroids and an albuterol inhaler. Her symptoms did not improve.

The numbness and tingling progressed to the point where she could no longer hold her toddler and dropped the child due to weakness in her arms.

Examination and Diagnosis

Motor examination revealed decreased tone, more significant in the upper limbs (3/5) than in the lower limbs (4/5), along with hyporeflexia in the biceps, triceps, patellar, and Achilles reflexes.

A lumbar puncture revealed elevated protein concentration (148 mg/dl; normal: 15-60 mg/dl).

The Western blot test for Lyme disease was positive. No one had suspected Lyme disease because her presentation lacked the classic signs.

Treatment and Recovery

The woman was prescribed IV ceftriaxone for 3 days before transitioning to oral doxycycline. At the time of discharge, she was able to move all extremities spontaneously and ambulate with a normal gait. At her follow-up visit, she exhibited only minimal residual weakness.

This case demonstrates that numbness and tingling from Lyme disease can resolve with appropriate antibiotic treatment — even when the presentation is atypical and diagnosis is delayed.

Clinical Perspective

This case illustrates the diagnostic challenges of Lyme neuropathy when classic symptoms are absent. A young woman presented with progressive full-body numbness and weakness severe enough to affect her ability to care for her child—yet had no tick bite recall, no rash, no fever, and no joint pain. Initial treatment with steroids failed because the underlying infection was missed. The hyporeflexia and elevated CSF protein pointed toward neurologic involvement, but without classic Lyme markers, the diagnosis was delayed. What makes this case particularly important is the reversibility. With appropriate antibiotic treatment, she recovered nearly full function within weeks. Had the infection remained undiagnosed and untreated, the neuropathy could have progressed to permanent nerve damage. The lesson: Lyme disease should be in the differential for any unexplained progressive neuropathy—regardless of whether classic symptoms are present.

Frequently Asked Questions

Can Lyme disease cause numbness and tingling?

Yes. Lyme disease can cause numbness and tingling anywhere in the body, including the torso, arms, legs, and face. Symptoms may start in one area and spread over time.

Can Lyme disease cause full-body numbness?

Yes. In this case, numbness and tingling that began in the abdomen eventually spread to the patient’s entire body, including weakness severe enough to impair daily function.

Can numbness and tingling from Lyme disease be reversed?

In many cases, yes. This patient recovered significantly after antibiotic treatment, regaining normal gait and near-full strength within weeks.

Do you need a tick bite or rash to have Lyme disease neuropathy?

No. This patient had no recalled tick bite, no rash, and none of the classic Lyme symptoms. Numbness and tingling were the primary presentation.

Why was Lyme disease missed initially?

The patient’s symptoms did not match the classic Lyme presentation. Without arthralgia, fever, or rash, clinicians prescribed steroids instead of testing for tick-borne infection.