Can Lyme Disease Cause Weakness and Hyporeflexia?
Lyme disease may rarely present with weakness and hyporeflexia
Neurologic Lyme disease can occur without classic Lyme symptoms
Sensory disturbances and reduced reflexes may delay diagnosis
This case involved a 25-year-old woman who experienced progressive numbness and tingling, beginning in her torso and eventually affecting her entire body.1
Over a four-week period, her neurological symptoms worsened, including a decrease in her reflexes (hyporeflexia), prompting her to seek care at a neurology clinic.1
Notably, she lacked the hallmark features typically associated with Lyme disease.
Instead, her clinical presentation was dominated by decreased reflexes (hyporeflexia) and sensory disturbances.1
Symptoms initially localized to the hypogastric region gradually radiated to her back and extremities.
“The numbness and tingling began on the right side of her stomach and radiated to her back and later spread to her entire body. The tingling was not associated with any burning or pins-and-needles sensation,” the authors wrote.1
For a broader overview of neurologic manifestations, visit our Neurologic Lyme Disease hub.
Watch the Inside Lyme discussion on weakness, hyporeflexia, and neurologic Lyme disease:
Alarming Progression of Symptoms
The symptoms significantly impaired her daily functioning, including her ability to care for her child.
“She especially became alarmed when she could not hold her toddler anymore and ended up dropping the child secondary to her numbness and tingling,” the authors reported.1
This case highlights how neurologic Lyme disease may progress gradually and mimic other neurologic disorders before the diagnosis becomes clear.
Neurological Findings
A motor examination revealed:
- decreased muscle tone, more pronounced in the upper limbs (3/5 strength) than in the lower limbs (4/5 strength)
- hyporeflexia in the biceps, triceps, patellar, and Achilles tendons
The patient also experienced progressive sensory symptoms affecting multiple regions of the body.1
Diagnostic Workup
A lumbar puncture revealed an elevated protein concentration in cerebrospinal fluid (148 mg/dL; normal range: 15–60 mg/dL), suggesting central nervous system involvement.1
The diagnosis of Lyme disease was confirmed via Western blot testing.
For more on delayed or atypical presentations, visit our Lyme Disease Misdiagnosis article.
Comparison to Logigian and Steere’s Findings
This case contrasts with findings from the 1990 study by Logigian and Steere published in The New England Journal of Medicine, which evaluated 27 patients with chronic neurologic Lyme disease.2
In that study, 25 of 27 patients (93%) had normal CSF results, including normal protein levels and no pleocytosis.2
This discrepancy underscores a key point: while CSF abnormalities may support the diagnosis of neurologic Lyme disease, their absence does not rule it out.
The variability in neurological presentations highlights the importance of clinical judgment.
Treatment and Outcome
The patient was initially treated with intravenous ceftriaxone for three days, followed by oral doxycycline.1
Her response to treatment was both rapid and substantial.
Upon discharge:
- she regained full spontaneous movement in all extremities
- her gait had normalized
“At the time of discharge, the patient was able to move all extremities spontaneously and ambulate with a normal gait,” the authors noted.1
Four Key Clinical Discussion Points
1. Neurological Manifestations of Lyme Disease
This case reinforces the importance of recognizing the diverse neurological presentations of Lyme disease.
As shown in the Logigian and Steere study, the absence of CSF abnormalities is not uncommon in chronic neurologic Lyme disease.2
Clinicians should consider Lyme disease even when classic signs are absent.
2. Role of Lumbar Puncture in Diagnosis
Although this patient had elevated CSF protein levels, many patients with neurologic Lyme disease may have normal CSF results.
This highlights the need to use a combination of clinical history, physical examination, and serologic testing when evaluating atypical neurologic symptoms.
3. Timely Diagnosis and Treatment
Despite a delay in diagnosis, the patient responded well to antibiotics.
The treatment regimen—IV ceftriaxone followed by oral doxycycline—was effective in managing Lyme neuroborreliosis in this case.1
4. Impact on Quality of Life
The patient’s neurological symptoms significantly affected her ability to care for her child.
Early recognition and treatment are important for restoring function and reducing disability.
Frequently Asked Questions
Can Lyme disease cause hyporeflexia?
Yes. Neurologic Lyme disease may occasionally present with decreased reflexes, also called hyporeflexia.1
Can Lyme disease cause weakness?
Some patients with Lyme neuroborreliosis develop muscle weakness, sensory changes, gait abnormalities, or impaired coordination.
Can Lyme disease mimic neurologic disorders?
Yes. Neurologic Lyme disease may resemble neuropathy, radiculopathy, Guillain-Barré syndrome, or other neurologic conditions.
Can neurologic Lyme disease occur without a bullseye rash?
Yes. Some patients with neurologic Lyme disease do not recall a tick bite or erythema migrans rash.
Can Lyme disease cause numbness and tingling?
Yes. Sensory disturbances including numbness, tingling, paresthesias, and abnormal sensations are recognized neurologic manifestations of Lyme disease.
Can neurologic Lyme disease improve with antibiotics?
Many patients improve with appropriate antibiotic treatment, although recovery timelines vary depending on severity and duration of illness.
Clinical Takeaway
Neurologic Lyme disease may present with weakness, hyporeflexia, sensory disturbances, and progressive neurologic symptoms even in the absence of classic Lyme disease findings.
This case highlights the importance of maintaining clinical suspicion when evaluating unexplained neurologic symptoms, particularly in endemic areas.
Hyporeflexia and progressive weakness may represent underrecognized manifestations of neurologic Lyme disease.
Related Articles
These related articles explore neurologic Lyme disease, atypical symptoms, sensory disturbances, and delayed diagnosis.
Lyme Disease Leads to Muscle Weakness of the Leg and Constipation
Atypical Symptoms of Lyme Disease: Numbness and Abdominal Wall Weakness
Lyme Disease Symptoms Guide
Delayed Lyme Disease Diagnosis
Post-Treatment Lyme Disease Syndrome
References
- Semy R, et al. Lyme Disease Presenting With Interesting Neurological Features of Weakness and Hyporeflexia: A Case Report.
- Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323:1438–1444.
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
