Lyme Disease and Guillain-Barré Syndrome
Lyme disease can rarely trigger Guillain-Barré syndrome
Neurologic Lyme disease may mimic autoimmune neuropathy
Early recognition and treatment may improve recovery
In a letter to the editor published in the Annals of Indian Academy of Neurology, Varma SY and colleagues described 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 overlap between infectious disease and autoimmune neurologic illness.
Initial presentation and symptoms
The patient initially presented with difficulty swallowing, slurred speech, weakness, and numbness involving both the upper and lower limbs.
These neurologic symptoms prompted urgent evaluation for a serious underlying neurologic disorder.
She also reported:
- Three episodes of loose stools
- Two episodes of vomiting
- One episode of fever with chills and rigors
Neurologic findings consistent with Guillain-Barré syndrome
Nerve conduction studies revealed a demyelinating sensory-motor polyneuropathy affecting both the upper and lower limbs.
The authors described “a demyelinating sensory-motor polyneuropathy affecting both the upper and lower limbs,” leading clinicians to diagnose Guillain-Barré syndrome.
GBS is typically considered an autoimmune condition in which the immune system attacks peripheral nerves, leading to progressive weakness, numbness, and sensory dysfunction.
Symptoms often begin in the legs and progress upward.
How Lyme disease entered the differential diagnosis
As the patient’s condition progressed, she developed bilateral facial nerve palsy, a recognized manifestation of neurologic Lyme disease.
This important clinical clue prompted testing for Borrelia burgdorferi, the bacterium responsible for Lyme disease.
Testing confirmed antibodies against Borrelia burgdorferi, leading clinicians to diagnose Guillain-Barré syndrome secondary to Lyme disease.
The association is considered rare, particularly in regions where Lyme disease is less commonly recognized.
Why infections can trigger Guillain-Barré syndrome
GBS frequently follows infections.
Common infectious triggers include:
- Campylobacter jejuni
- Cytomegalovirus
- Epstein-Barr virus
- Respiratory infections
Lyme disease represents a far less common trigger, but this case demonstrates that infectious neurologic disease may occasionally mimic primary autoimmune neuropathy.
Clinicians may need to consider Lyme disease in patients presenting with:
- Cranial nerve involvement
- Bilateral facial palsy
- Peripheral neuropathy
- Possible tick exposure
- Multisystem symptoms
Treatment and outcome
The patient received treatment targeting both the autoimmune and infectious aspects of her illness.
- Intravenous immunoglobulin (IVIg)
- Gabapentin for neuropathic pain
- Intravenous ceftriaxone for 14 days
The patient improved following treatment with resolution of neurologic symptoms.
The case highlights the importance of identifying infectious contributors when evaluating complex neurologic presentations.
Neurologic manifestations of Lyme disease
Lyme neuroborreliosis may involve multiple neurologic complications, including:
- Cranial nerve palsies
- Meningitis
- Radiculopathy
- Peripheral neuropathy
For additional neurologic symptom patterns, see our Lyme disease symptoms guide.
Frequently Asked Questions
Can Lyme disease cause Guillain-Barré syndrome?
Yes. Lyme disease is a rare but recognized infectious trigger for Guillain-Barré syndrome.
What symptoms overlap between Lyme disease and GBS?
Weakness, numbness, facial palsy, neuropathy, and sensory changes may overlap between the two conditions.
Can a tick bite trigger Guillain-Barré syndrome?
In rare cases, infection following a tick bite may contribute to Guillain-Barré syndrome development.
Why is bilateral facial palsy important in Lyme disease?
Bilateral facial palsy is a recognized neurologic manifestation of Lyme disease and may help distinguish Lyme neuroborreliosis from other neurologic disorders.
Can Lyme-related neurologic symptoms improve with treatment?
Some neurologic Lyme disease symptoms may improve with timely recognition and appropriate antimicrobial treatment.
Clinical Takeaway
Guillain-Barré syndrome is most commonly associated with autoimmune and post-infectious mechanisms, but Lyme disease may occasionally act as an infectious trigger.
Neurologic Lyme disease should remain part of the differential diagnosis in patients presenting with cranial neuropathies, peripheral neuropathy, or atypical Guillain-Barré syndrome presentations.
Related Articles
Patients with neurologic Lyme disease symptoms may also explore related articles involving autoimmune overlap, neuropathy, and delayed diagnosis.
Lyme disease triggers autoimmune disease
Can Lyme disease trigger an autoimmune disease?
Lyme disease manifests as autoimmune disorder – Sjogren’s syndrome
Lyme disease misdiagnosis
Persistent Lyme disease
References
- 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.
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
At the bottom of the article, it says that Lyme disease is extremely rare disease? I do not agree with that at all. I’m quite frankly very surprised to see such a statement made on Dr. Cameron’s website. Put it this way I know way more people that have had Lyme disease than I know that have had Covid.
I was referring to Lyme disease as a cause of Guillain-Barré. At least I have not seen it.
I have same condition. 4 years in i don’t have drs that care enough to understand my issues. Lost quality of life. My legs are weak after a small remission I found ninbness in legs returned i cant walk far and emotional im numb. In pain all day every day.
I encourage my patients to look for an underlying illness if they remain ill.
Do you know of post treatment lyme disease and flare ups?
Thank you for replying. I have no insurance and lost everything i worked for.
Theres a treatment that im looking into but its over $8000.
Has to to with phage something?
Do you have any insight? Im tired of feeling like im worthless. Ill be 50 in May. I’ve lost so many years.
Thank you again for taking the time to reply.
I’m sorry you’re going through this. Lyme and flare-ups can be very discouraging.
I’m aware of phage therapy, but I haven’t used it for Lyme and am waiting for more data especially given the cost.
It actually says that Lyme disease should be considered when possibly diagnosing Guillain Barre, even in areas where Lyme disease is rare.
In many areas, Lyme is very prevalent, as in your experience, but in other places it is rare.
I looking for help. I feel like where I’m at Noone understands my illness. I have been confirmed diagnosed Guillain-Barre syndrome and post treatment lyme disease with chronic mono. I want to live but I think my life will be cut short or miserable if I continue to be untreated.
I have patients with PTLDS who were never informed that their condition could be from a persistent infection. You can read more in my blog.https://danielcameronmd.com/she-was-told-to-wait-then-told-it-was-ptlds-but-her-lyme-infection-never-left/