Can Lyme Disease Mimic Guillain-Barré Syndrome? A Missed Diagnosis
Lyme neuroborreliosis can resemble Guillain-Barré syndrome (GBS).
Weakness, numbness, facial palsy, and paralysis may overlap clinically.
When standard GBS treatment fails, Lyme disease should be reconsidered.
Can Lyme disease look like Guillain-Barré syndrome (GBS)? Yes. In some cases, Lyme neuroborreliosis can cause progressive weakness, numbness, facial palsy, and even paralysis—closely resembling GBS.
When treatment for GBS fails, an underlying infection such as Lyme disease may be the missing diagnosis.
For a broader overview of neurologic Lyme disease, see our main guide.
What Is Guillain-Barré Syndrome?
Guillain-Barré syndrome (GBS) is a neurologic disorder that can range from mild weakness to severe paralysis affecting breathing and mobility.
GBS often develops after an infection.
According to the Cleveland Clinic, symptoms typically begin within one to six weeks following an illness, though GBS has also been associated with surgery and vaccination.
Patients commonly develop weakness, numbness, loss of reflexes, and progressive paralysis.
Because Lyme neuroborreliosis can produce many of these same neurologic findings, diagnostic confusion may occur early in the disease course.
Case Report: Lyme Disease Misdiagnosed as GBS
In the article, “Neuroborreliosis presenting as Guillain-Barré syndrome”, Farr et al. describe a 33-year-old man whose clinical, radiographic, and neurodiagnostic findings strongly suggested GBS.
The patient presented to the emergency department with progressive weakness and numbness in his hands and feet following an upper respiratory infection and an abdominal rash.
“The patient reported that his symptoms started one week ago as a ‘tingling sensation’ in his hands and feet with perioral numbness along with a concurrent fever, nonproductive cough, and a ‘blotchy’ abdominal rash,” the authors state.
Neurologic examination revealed bilateral facial palsy, reduced reflexes at the knees and ankles, and sensory loss in the arms and legs.
MRI and electromyography (EMG) findings were also consistent with Guillain-Barré syndrome.
Because of concern for GBS, the patient was treated with intravenous immunoglobulin (IVIG), the standard therapy for Guillain-Barré syndrome.
When Treatment Failed
The patient did not improve.
Instead, his condition worsened, eventually requiring a tracheostomy because of respiratory complications.
This lack of response raised an important question:
What if this wasn’t Guillain-Barré syndrome?
Since he did not respond to IVIG treatment, the patient was tested for Lyme disease, as he reported frequently being in wooded areas and had an abdominal rash, along with fever and cough before developing GBS-like symptoms.
Western blot testing was positive for Lyme disease.
He was diagnosed with neurologic Lyme disease (neuroborreliosis).
After treatment with intravenous ceftriaxone and doxycycline, his symptoms improved significantly and recovery continued over several months.
Eight months after symptom onset, the patient had recovered substantially.
Why Lyme Disease Can Mimic GBS
Lyme neuroborreliosis can produce neurologic symptoms that overlap significantly with Guillain-Barré syndrome.
These may include progressive weakness, numbness and tingling, loss of reflexes, facial palsy, and respiratory compromise.
This overlap can lead to delayed diagnosis—especially when Lyme disease is not initially suspected.
This reflects a broader pattern seen in Lyme disease misdiagnosis.
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
Recognizing this pattern may help avoid delayed diagnosis and unnecessary complications.
Clinical Takeaway
Lyme disease can closely mimic Guillain-Barré syndrome.
Symptoms may include weakness, numbness, facial palsy, and paralysis severe enough to require respiratory support.
When standard GBS treatment fails or symptoms follow a possible tick exposure, Lyme neuroborreliosis should remain part of the differential diagnosis.
Frequently Asked Questions
Can Lyme disease mimic Guillain-Barré syndrome?
Yes. Lyme neuroborreliosis may cause weakness, numbness, facial palsy, and paralysis resembling GBS.
What symptoms overlap between Lyme disease and GBS?
Both conditions may cause weakness, sensory loss, loss of reflexes, facial palsy, and progressive neurologic dysfunction.
Why can Lyme disease be mistaken for GBS?
Neurologic Lyme disease can produce similar clinical findings, MRI abnormalities, and EMG results.
When should Lyme disease be considered in suspected GBS?
Lyme disease should be reconsidered when patients have outdoor exposure, rash history, facial palsy, or fail to improve with standard GBS therapy.
Related Articles
- Tick bite leads to Guillain-Barre Syndrome
- Lyme disease another infection associated with onset of Guillain-Barre Syndrome?
- Conversion disorder, Guillain-Barre Syndrome or Lyme disease?
References
- National Institute of Neurological Disorders and Stroke. Guillain-Barré Syndrome.
- Cleveland Clinic. Guillain-Barré Syndrome.
- Farr J, Bittar J. Neuroborreliosis presenting as Guillain-Barré syndrome. Cureus. 2023;15(7):e42322.
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.