In a letter to the editor published in the Annals of Indian Academy of Neurology, Varma SY and colleagues¹ describe a rare and clinically significant case of Guillain-Barré Syndrome (GBS) triggered by Lyme disease in a 50-year-old woman. This case highlights the complex interplay between infectious diseases and autoimmune disorders.

Initial Presentation and Symptoms

The patient initially presented with:

• Difficulty swallowing

• Slurred speech

• Weakness and numbness in both upper and lower limbs

These neurological symptoms prompted an urgent and thorough evaluation for a serious underlying condition.

She also reported additional systemic symptoms:

• Three episodes of loose stools

• Two episodes of vomiting

• One episode of fever with chills and rigors

Guillain-Barré Syndrome: Diagnostic Findings

Neurological Examination

Key findings included:

• Three episodes of loose stools

• Two episodes of vomiting

• One episode of fever with chills and rigors

Nerve Conduction Studies

Nerve conduction studies revealed:

“A demyelinating sensory-motor polyneuropathy affecting both the upper and lower limbs, leading to a diagnosis of Guillain-Barré Syndrome (GBS),” the authors wrote.

GBS is an autoimmune condition in which the immune system mistakenly attacks peripheral nerves, leading to progressive weakness and numbness, typically beginning in the legs and ascending to the upper body.

Link to Lyme Disease

As the patient’s condition progressed, she developed bilateral facial nerve palsy—a rare but recognized manifestation of Lyme disease. This clinical clue prompted testing for Borrelia burgdorferi, the bacterium responsible for Lyme disease.

Test results confirmed the presence of antibodies against Borrelia burgdorferi, leading to a diagnosis of GBS secondary to Lyme disease. This association is exceedingly rare, especially in India, where Lyme disease is uncommon.

Treatment and Outcome

The patient was treated with a combination of therapies targeting both the autoimmune and infectious components of her illness:

• Intravenous Immunoglobulin (IVIg) – to modulate the immune response responsible for GBS

• Gabapentin – for neuropathic pain relief

• IV Ceftriaxone (14 days) – to treat the underlying Lyme disease

The patient responded well, with resolution of her neurological symptoms following the dual treatment approach.

Discussion

1. Guillain-Barré Syndrome and Infections

GBS is frequently triggered by infections, commonly by Campylobacter jejuni, cytomegalovirus, or Epstein-Barr virus. Lyme disease is an extremely rare cause. This case underscores the need to consider Lyme disease in GBS patients, particularly those presenting with cranial nerve involvement and a potential history of tick exposure.

2. Three Neurological Manifestations of Lyme Disease

Lyme neuroborreliosis encompasses several neurological complications, including:

1. Cranial nerve palsies (e.g., facial nerve palsy)
2. Meningitis
3. Radiculopathy
4. Peripheral neuropathy

The patient’s bilateral facial nerve palsy served as a key diagnostic clue in this case.

3. Early Diagnosis and Targeted Treatment

The patient’s rapid improvement following treatment with IVIg and ceftriaxone highlights the importance of early and accurate diagnosis. Failure to identify an infectious trigger in GBS can delay effective treatment and worsen outcomes.

Conclusion

This case emphasizes the importance of including Lyme disease in the differential diagnosis of Guillain-Barré Syndrome—especially in patients with cranial nerve involvement or potential tick exposure, even in regions where Lyme disease is rare. Prompt recognition and targeted treatment can significantly improve outcomes in such complex cases.

Reference

1. Sudheer Varma Y, et al. Lyme Disease as an Extremely Rare Cause of Guillain-Barré Syndrome in India. Annals of Indian Academy of Neurology, 2020.