Lyme Disease and Guillain-Barre Syndrome (GBS)
Weakness and nerve symptoms may have multiple causes
Lyme disease can occasionally resemble or accompany Guillain-Barre syndrome
Early recognition may improve diagnosis and treatment decisions
Lyme disease Guillain-Barre syndrome cases are uncommon, but clinicians practicing in endemic regions may need to consider Lyme disease when patients present with rapidly progressive neurologic symptoms.
Guillain-Barre syndrome (GBS) is an autoimmune disorder in which the immune system mistakenly attacks peripheral nerves outside the brain and spinal cord. Symptoms often begin with weakness, tingling sensations, or numbness in the legs before spreading upward.1
Because neurologic Lyme disease may mimic multiple neurologic disorders, distinguishing Lyme disease from Guillain-Barre syndrome—or identifying cases where both may coexist—can complicate diagnosis.
Some patients search for “Guillian-Barre syndrome,” but the correct spelling is Guillain-Barre syndrome (GBS).
See also: Neurologic Lyme disease
Neurologic symptoms raise concern for Guillain-Barre syndrome
This patient reported three episodes of loose stools, two episodes of vomiting, and one episode of fever with chills and rigors before developing neurologic symptoms.1
A neurologic examination revealed bulbar palsy involving the ninth and tenth cranial nerves, reduced tone in all four limbs, absent lower-extremity deep tendon reflexes, and absent bilateral plantar reflexes.1
Nerve conduction studies suggested a demyelinating sensory-motor polyneuropathy affecting both upper and lower limbs, leading clinicians to diagnose Guillain-Barre syndrome (GBS).1
When Lyme disease enters the differential diagnosis
The patient later developed bilateral lower motor neuron facial nerve palsy, prompting clinicians to investigate additional causes for the neurologic presentation.1
Testing for Lyme disease returned positive, leading clinicians to diagnose Guillain-Barre syndrome secondary to Lyme disease.1
Clinicians practicing in endemic regions may need to consider Lyme disease when evaluating atypical neurologic presentations, particularly when cranial neuropathies or facial nerve palsies emerge.
See also: Lyme disease symptoms guide
How was the patient treated?
The patient received intravenous immunoglobulin (IVIg), gabapentin, and a 14-day course of intravenous ceftriaxone.1
The report highlights how management may involve treating both the autoimmune neurologic syndrome and the underlying infectious trigger when present.
Can Lyme disease mimic Guillain-Barre syndrome (GBS)?
Neurologic Lyme disease may occasionally resemble Guillain-Barre syndrome because both conditions can involve weakness, sensory abnormalities, cranial neuropathies, and abnormal reflexes.
Several neurologic conditions may mimic Guillain-Barre syndrome including neurologic Lyme disease, neuropathies, autoimmune disorders, infections, metabolic conditions, and other inflammatory neurologic diseases. The overlap can complicate diagnosis when weakness, sensory symptoms, and abnormal reflexes coexist.1
Because diagnostic overlap exists, Lyme disease should remain part of the differential diagnosis in appropriate geographic and clinical settings.
See also: Persistent Lyme disease symptoms
Frequently Asked Questions
Can Lyme disease cause Guillain-Barre syndrome?
Rare case reports describe Lyme disease occurring alongside or potentially contributing to Guillain-Barre syndrome presentations.
Can a tick bite cause Guillain-Barre syndrome?
Rare reports suggest tick-borne infections including Lyme disease may occasionally be associated with Guillain-Barre syndrome-like presentations.
What symptoms overlap between Lyme disease and Guillain-Barre syndrome?
Weakness, sensory changes, facial palsy, abnormal reflexes, and neuropathy may overlap.
What mimics Guillain-Barre syndrome?
Neurologic Lyme disease, neuropathies, autoimmune disorders, infections, metabolic conditions, and other inflammatory neurologic diseases may occasionally resemble Guillain-Barre syndrome.
Is Guillain-Barre syndrome upper or lower motor neuron?
Guillain-Barre syndrome is generally considered a peripheral nervous system disorder affecting lower motor neuron pathways because it involves peripheral nerves rather than the brain or spinal cord.
Clinical Takeaway
Guillain-Barre syndrome associated with Lyme disease appears uncommon, but atypical neurologic presentations may require broader diagnostic thinking.
Facial palsy, cranial neuropathies, and neurologic symptoms in endemic regions may justify considering Lyme disease in the differential diagnosis.
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References
- Varma YS, Kumar V, Agarwal K, Biswas R, Adil M. Lyme Disease as an Extremely Rare Cause of Guillain-Barre Syndrome in India. Neurol India. 2024;72:1102.
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
Can I ask, does a borderline equivocal test mean more likely for Lyme than not? I have positive, infected tick bites, Queensland Australia, have pictures, have developed Pancreatic Enzyme Deficiency with a normal looks pancreas on multiple imaging over 4 years, chronically inflamed gallbladder that was removed 2022, infected perforated Appendix removed 2,5 months ago, platelets, haemoglobin, neuts or below bottom of the range, rigor, left sided weakness, wedge fracture in my T6 last month. Neurological issues. Barely move after exerting myself, passed out Christmas Day from the pain last year, have daily attacks. But now they say no chronic pancreatitis. I Did drink sewage infected water in 2012, no signs, was a waterfall spring overflowed with town sewage unbeknownst to me. Fibromyalgia like illness diagnosed in 2013. I feel like something is underlying here and it’s infecting me, non essential organs so far, both now gone. I wonder what’s next. I’ve lost 24 kg and 3cm height, can’t work and help care for my wife, I’ve never smoked, rarely had one drink. Please help sir
I wish tests for Lyme and co-infections were more reliable. I have not found borderline tests as helpful as I would like. I have had to rely on clinicial judgment after ruling out other infections.