Borrelia mayonii is a recently discovered species that causes Lyme disease with atypical features. Since the species was first identified 7 years ago, there have been only 7 reported cases of Lyme disease caused by Borrelia mayonii.

In Open Forum Infectious Diseases Correspondence, McGowan and colleagues describe the recent case of a Borrelia mayonii infection in a 51-year-old man from northern Minnesota.

The case is featured in a Letter to the Editor, entitled “Acute Lyme Disease With Atypical Features due to Borrelia mayonii.“²

“Lest there be any doubt of the ongoing clinical relevance of B mayonii in the upper Midwest, we describe a recent case from northern Minnesota.”

Case report

A 51-year-old man was admitted to the hospital with fever, shaking chills, intense headache, intermittent confusion, diffuse arthralgias, dry cough, generalized weakness, and mild dyspnea. His symptoms had been ongoing for two days.

“For the past 2 weeks, he had been felling trees and clearing brush on his property in rural Minnesota,” the authors state.

The patient had patches of confluent macular erythema on his torso.

Borrelia mayonii confirmed

PCR testing was positive for Borrelia mayonii. Other Borrelia species, including B burgdorferi, garinii, and afzelii, were not detected.

The patient was treated successfully for Lyme disease with IV ceftriaxone, followed by doxycycline.

Atypical symptoms of Borrelia mayonii

Several of the patient’s symptoms were not typical for an infection with B. burgdorferi, including patchy macular erythema, high fever, and encephalopathy, the authors state.

“Notably, each of these signs/symptoms was present in at least 50% of the B. mayonii–infected patients described in the original report, providing potential clues for diagnosis.”

Authors’ recommendations

In patients who are acutely ill and have at least 2 of the above-mentioned clinical features, along with Midwestern tick exposure, the diagnostic workup should include molecular testing for B. mayonii in the blood and/or CSF.