She was in her late 60s. No autoimmune history. No recent travel. But she was getting weaker. Her joints ached. Her memory was slipping. Her balance felt off. She woke up exhausted, sometimes with her heart racing.
She was told it was aging.
Then anxiety.
Then nothing more could be done.
But when we looked closer, the story pointed to Lyme disease.
Lyme Is Still Being Missed — And the Cost Is High
I’ve seen this story play out too often: an older adult with multisystem symptoms is misdiagnosed or dismissed. Instead of infection, they’re told it’s aging, depression, menopause, or stress. But when Lyme disease is missed—especially in older adults—the results can be devastating.
Fortunately, published case reports show that recognition and treatment can dramatically change outcomes.
🧠 Neurologic Lyme That Looked Like Dementia or Stroke
Case 1: Reversible Dementia in a 75-Year-Old Man
A man was admitted to an Alzheimer’s unit with hallucinations, confusion, aggression, incontinence, and insomnia. Imaging was unremarkable, but Lyme serology was positive. After a 21-day IV ceftriaxone course, many symptoms reversed [1].
Takeaway: Lyme neuroborreliosis can mimic dementia but may be treatable if caught in time.
Case 2: Stroke in a 83-Year-Old Man
An 83-year-old presented with sudden weakness and speech loss. No vascular risk factors were found, but blood and CSF were positive for Borrelia. Treated with IV antibiotics, he stabilized [2].
Takeaway: Lyme should be considered in elderly stroke patients with no clear cause.
Case 3: Recurrent Strokes From Cerebral Vasculitis
A 58-year-old man had repeated strokes in the same brain region over a year. Serology confirmed Lyme. After doxycycline, strokes stopped [3].
Takeaway: Lyme-induced vasculitis is rare but serious—and treatable with antibiotics.
❤️ Lyme Carditis and Heart Block
Case 4: Third-Degree AV Block Reversed by Treatment
A patient developed a complete heart block due to Lyme carditis. With IV ceftriaxone and temporary pacing, heart rhythm normalized, avoiding a permanent pacemaker [4].
Takeaway: Cardiac Lyme can cause life-threatening conduction issues—but can be reversed with early antibiotics.
⚡ When Lyme Doesn’t Look Like Lyme
Case 5: Seizures in a 55-Year-Old Man
A man with no Lyme symptoms presented with generalized seizures. Lyme serology and CSF confirmed neuroborreliosis. After ceftriaxone, seizures resolved [5].
Takeaway: Lyme may present as seizures—even without a rash or flu-like symptoms.
Case 6: Neuroborreliosis Without Rash in an 84-Year-Old
An elderly man developed confusion and headaches—without a rash. Lyme testing was positive. With early antibiotics, he fully recovered [6].
Takeaway: In older adults, neuroborreliosis may be the first or only symptom of Lyme.
🦶 Peripheral Neuropathy and Musculoskeletal Damage
Case 7: Charcot-Like Neuropathy From Untreated Lyme
A patient developed a rare, deforming foot neuropathy resembling Charcot foot. Testing confirmed untreated Lyme disease [7].
Takeaway: Lyme can cause progressive neuropathy and foot deformities if left untreated.
🩺 The Bigger Picture
These aren’t theoretical risks—they’re real, published cases.
And they all point to one conclusion: Lyme disease in older adults doesn’t always look classic—but it can be life-changing when caught and treated.
🧭 What Clinicians Should Remember
- Lyme is not just a disease of the young
- A negative test doesn’t rule it out—especially in late-stage disease
- Neurologic, cardiac, and systemic complications are treatable if recognized early
- Clinical suspicion should be higher when symptoms are unexplained or progressive
💬 Final Thoughts
Some of my sickest Lyme patients didn’t fit the mold.
They were too old.
Too polite.
Too willing to believe it was “just aging.”
But Lyme doesn’t respect age.
And when it’s missed, it doesn’t stay quiet.
If you’re a clinician: Think broader. Don’t let age or geography steer you away from Lyme.
If you’re a patient: If something feels wrong, don’t give up. Keep asking.
Because sometimes it is Lyme.
And sometimes, it’s not too late.
🧾 References
- Schiraldi F, Capodicasa E, Della Marca G, et al. Dementia and hallucinations in late Lyme disease. Aging Clin Exp Res. 2018;30(8):951–953.
- Baj J, Flieger W, Teresiński G, et al. Lyme neuroborreliosis as a cause of ischemic stroke in an elderly patient: a case report. BMC Infect Dis. 2020;20(1):289.
- Back T, Grünig S, Winter Y, et al. Recurrent stroke due to cerebral vasculitis: rare presentation of neuroborreliosis. Cerebrovasc Dis. 2013;36(1):64–65.
- McAlister HF, Klementowicz PT, Andrews C, et al. Cardiac manifestations of Lyme disease: case reports and literature review. Can J Cardiol. 1989;5(5):253–257.
- Müllegger RR, Glatz M. Lyme borreliosis: Clinical manifestations, diagnosis, and management. Curr Probl Dermatol. 2009;37:18–38.
- Holt DC, Luu M, Bell C, et al. Neuroborreliosis without erythema migrans in an elderly patient. Med J Aust. 2005;182(6):295–296.
- Situm M, Ljubojević Hadžavdić S, et al. Peripheral neuropathy and Charcot foot deformity as a rare manifestation of Lyme disease. Acta Dermatovenerol Croat. 2017;25(2):137–139.
