Can Lyme Disease Mimic Guillain-Barré Syndrome? A Missed Diagnosis
Can Lyme disease look like Guillain-Barré syndrome (GBS)? Yes. In some cases, Lyme neuroborreliosis can cause progressive weakness, numbness, and even paralysis—closely resembling GBS.
When treatment for GBS fails, an underlying infection such as Lyme disease may be the missing diagnosis.
Case Report: Lyme Disease Misdiagnosed as GBS
A 33-year-old man presented with progressive weakness and numbness in his hands and feet following an upper respiratory infection.
His symptoms included:
- Tingling in hands and feet
- Facial numbness
- Fever and cough
- Blotchy abdominal rash
Neurologic exam revealed:
- Bilateral facial palsy
- Reduced reflexes
- Sensory loss in the limbs
MRI and EMG findings were consistent with Guillain-Barré syndrome.
He was treated with intravenous immunoglobulin (IVIG)—the standard therapy for GBS.
When Treatment Failed
The patient did not improve.
Instead, his condition worsened, eventually requiring a tracheostomy due to respiratory complications.
This lack of response raised an important question:
What if this wasn’t Guillain-Barré syndrome?
The Missing Diagnosis: Lyme Neuroborreliosis
Because of his exposure history and rash, the patient was tested for Lyme disease.
Western blot testing was positive.
He was diagnosed with neurologic Lyme disease (neuroborreliosis).
After treatment with intravenous ceftriaxone and doxycycline:
- His symptoms improved significantly
- Recovery continued over several months
Eight months later, he had recovered substantially.
Why Lyme Disease Can Mimic GBS
Guillain-Barré syndrome typically develops after infection and can cause:
- Weakness
- Numbness
- Loss of reflexes
- Paralysis
Lyme neuroborreliosis can produce many of the same neurologic features.
This overlap can lead to misdiagnosis—especially early in the disease course.
When to Suspect Lyme Disease Instead
Lyme disease should be considered when:
- Symptoms follow tick exposure or outdoor activity
- A rash or flu-like illness preceded neurologic symptoms
- There is no improvement with standard GBS treatment
- Symptoms include facial palsy or multisystem involvement
This reflects a broader pattern seen in Lyme disease misdiagnosis.
Clinical Takeaway
Lyme disease can closely mimic Guillain-Barré syndrome.
- Symptoms may include weakness, numbness, and paralysis
- Standard GBS treatment may fail
- Infection should be considered when patterns don’t fit
Recognizing this possibility can lead to appropriate treatment and recovery.
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
I remember only having a rash like this one other time and it was the same summer as the worst “summer flu” ever.
This time, the rash is also on the smalls of my back, and small raised bumps itching between left ring finger and index with one spot appearing randomly in other areas that disappear soon after starting.
All started as an allergy type rash white raised a bit like a bug bites but turn red and to a burning itch such as a nettle burn. The smalls of my back appeared lightly on one side the first day increasing on day 2 and 3 while the stomach rash seems to be subsiding. The tick was negative this time for Lyme but positive for babesia odocoilei. My feet have increased burning, I have developed a slight cough over the day prior to the rash and the next 2 days, sore nose cartridge only on one nostril, cramping of the left hand periodically, bruises on both left and right side hip and outer thy areas along with calf area but all bruises look different.
I was very lethargic 3 days before the rash appeared. The day it appeared, I felt fine otherwise. On the second day, I woke with a sore throat so I tested for covid, which was negative.
After reading this article it reminded me that that first summer flu and the belly rash was the beginning of Ms like symptoms that turned my right side inward.
Since, I have suffered several emergency visits for various issues that do not run in the family.
Heart, stroke, ostioma, adrenal mass, thyroid and parathyroid masses, lung mass, kidney stones as large as 7 mm, with small masses, a tortioned ovarian cyst as large as a soda bottle the nurse described. As well as neurological and physical issues, now also having severe osteoporosis.
Tick-borne diseases are still not looked at in the same way even covid is. The lucky ones get to see doctors and professionals such as in this story, that will go beyond and find root causes to treat with iv.
Only once since my first “summer flu” I felt normal for 3 days and it was after an er visit that I received and iv treatment of an antibiotic that I can only remember started with a c.
For 3 days, in over 15 yrs, I had no pain, no numbness, no mental fog, and could even run!
Keep helping patients for as long as you can and longer…
TBRF/RMSF does more than just mimic Gullian-Barre’, getting a COVID Booster shot caused my GD1b antibodies to be activated, while simultaneously IFA positive for RMSF during serial blood testing over the course of 4 COVID shots.
GD1b antibodies can be activated by a number of conditions
My husband has tested positive for several lyme, co-infections, and viruses – and now suffering from MND mimicking symptoms. Neurologists completely dismissed idea of Lyme and we lost many months, now on an antibiotic protocol but not confident and would like another opinion. Is this an area you are familiar with to treat?
I don’t have many patients with motor neurone disease (MND). They usually stay with neurology. I have had to treat some of them for a persistent tick borne infection to rule out any underlying factors but the results are mixed. I have patients with both Lyme and MND whose Lyme disease symptoms improve which helps their quality of life.