Lyme Disease and Guillain-Barré Syndrome: When Lyme Mimics GBS
Weakness begins in the legs.
It spreads—and becomes harder to explain.
This is where Lyme disease can be missed.
Lyme disease can mimic Guillain-Barré syndrome (GBS), a neurologic condition that causes progressive weakness and nerve dysfunction.
This is where neurologic Lyme disease is often misdiagnosed.
This is where one diagnosis can overshadow another.
Guillain-Barré syndrome is an autoimmune disorder in which the immune system attacks peripheral nerves, leading to weakness, tingling, and sometimes paralysis.
This case highlights how Lyme disease can overlap with other neurologic conditions.
Start here: Lyme disease symptoms guide
See also: Neurologic Lyme disease
What Are the Symptoms of Guillain-Barré Syndrome?
What does GBS typically look like?
Symptoms often begin subtly and may include:
- Weakness or tingling in the legs
- Spread of symptoms to the arms and upper body
- Reduced or absent reflexes
This is where symptoms can progress rapidly.
In some cases, patients may also experience cranial nerve involvement, affecting speech, swallowing, or facial movement.
Neurologic Lyme disease is a recognized cause of cranial neuropathies and peripheral nerve involvement.
What Happened in This Case?
How did this patient present?
The patient reported:
- Episodes of diarrhea and vomiting
- Fever with chills and rigors
- Progressive neurologic symptoms
Neurologic examination revealed:
- Bulbar palsy involving cranial nerves IX and X
- Reduced tone in all four limbs
- Absent deep tendon reflexes in the lower limbs
- Absent bilateral plantar reflexes
This is where findings pointed toward a serious neurologic disorder.
Nerve conduction studies showed a demyelinating sensory-motor polyneuropathy, consistent with Guillain-Barré syndrome.
When Was Lyme Disease Considered?
This is where the diagnosis shifted.
The patient later developed bilateral facial nerve palsy, a finding that raised suspicion for Lyme disease.
Testing for Lyme disease returned positive.
This is where Lyme disease explained the full clinical picture.
The patient was diagnosed with Guillain-Barré syndrome secondary to Lyme disease.
How Was the Patient Treated?
What happens when both conditions are treated?
The patient received:
- Intravenous immunoglobulin (IVIg)
- Gabapentin for symptom control
- A 14-day course of intravenous ceftriaxone
This is where recognizing Lyme disease can change management.
Why This Case Matters
What should clinicians consider?
Lyme disease can present with neurologic symptoms that closely resemble Guillain-Barré syndrome.
This overlap can delay diagnosis if Lyme disease is not included in the differential.
This is where important diagnoses can be missed.
See related discussion: Lyme neuroborreliosis mimicking GBS
Clinical Takeaway
Lyme disease should be considered in patients presenting with unexplained neurologic symptoms, especially in endemic areas.
Overlapping conditions such as Guillain-Barré syndrome may complicate diagnosis.
If neurologic symptoms don’t fully fit Guillain-Barré syndrome, it’s worth asking why—again.
Related Reading
- Lyme neuroborreliosis mimics Guillain-Barré syndrome
- Tick bite leads to Guillain-Barré syndrome
- GBS or Lyme disease?
References
- Varma, Y. S., Kumar, V., Agarwal, K., Biswas, R., & Adil, M. (2024). Lyme disease as an extremely rare cause of Guillain-Barré syndrome in India. Neurology India, 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.