Lyme Disease
Lyme Disease
Misdiagnosing Lyme disease
Lyme disease symptoms similar to other diseases
The Borrelia burgdorferi (Bb) spirochete is an evasive organism which can penetrate virtually any organ or system in the body, including the brain and central nervous system, joints, muscles and heart. Lyme disease symptoms may be similar to other medical conditions, making diagnosing a challenge. For this reason, Lyme disease and syphilis have both been coined “the great imitator.” These diagnostic challenges are compounded by widespread Lyme disease misconceptions that lead clinicians away from considering tick-borne illness.
Types of MIsdiagnosis
Why Lyme Is Called “The Great Imitator”
Lyme disease mimics dozens of conditions because Borrelia burgdorferi affects multiple organ systems. This diagnostic complexity—combined with unreliable testing and lack of physician awareness—leads to misdiagnosis in 30-50% of cases.
Misdiagnosis and similar symptoms
Misdiagnosis Reported Cases
Rheumatoid Arthritis
Steere et al. described Lyme disease cases that were misdiagnosed as Juvenile Rheumatoid Arthritis (JRA). 8
Cellulitis
Nowakowski and Feder reported cases misdiagnosed as cellulitis. 9,10
Common Skin Rash
Plotkin described a 39-year-old male with a retropopliteal rash that progressed, within three weeks to Lyme disease, with a loss of consciousness and a complete heart block that required insertion of a transvenous cardiac pacemaker. 11
Multiple Sclerosis
Lyme disease has been mistaken for multiple sclerosis (MS). 12,13 In fact, one author estimated that 5% – 10% of patients presumed to have MS suffered from other conditions including Lyme disease. 14
Anterior Ischemic Optic Neuropathy
Three cases of neuroborreliosis were initially misdiagnosed as anterior ischemic optic neuropathy caused by giant cell arteritis. Neuropsychiatric presentations, including depression, anxiety, and rage, have been identified in both acute and chronic Lyme disease cases. 15
Polymyalgia Rheumatica
Lyme disease has also been mistaken for polymyalgia rheumatica 16,17, sports-related injuries 18, and common medical conditions such as sinusitis, Epstein-Barr syndrome, rotator cuff tear, meniscus tear, edema, cellulitis, and pericarditis. 19
- Goldenberg DL. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol, 6(2), 223-233 (1994).
- Clauw DJ, Chrousos GP. Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms. Neuroimmunomodulation, 4(3), 134-153 (1997).
- Naesens R, Vermeiren S, Van Schaeren J, Jeurissen A. False positive Lyme serology due to syphilis: report of 6 cases and review of the literature. Acta Clin Belg, 66(1), 58-59 (2011).
- Cimmino MA, Salvarani C. Polymyalgia rheumatica and giant cell arteritis. Baillieres Clin Rheumatol, 9(3), 515-527 (1995).
- Paparone PW. Polymyalgia rheumatica or Lyme disease? How to avoid misdiagnosis in older patients. Postgrad Med, 97(1), 161-164, 167-170 (1995).
- Schwartzberg M, Weber CA, Musico J. Lyme borreliosis presenting as a polymyalgia rheumatica-like syndrome. Br J Rheumatol, 34(4), 392-393 (1995).
- Daoud KF, Barkhuizen A. Rheumatic mimics and selected triggers of fibromyalgia. Curr Pain Headache Rep, 6(4), 284-288 (2002).
- Steere AC, Malawista SE, Snydman DR et al. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three connecticut communities. Arthritis Rheum, 20(1), 7-17 (1977).
- Feder HM, Jr., Whitaker DL. Misdiagnosis of erythema migrans. Am J Med, 99(4), 412-419 (1995).
- Nowakowski J, McKenna D, Nadelman RB et al. Failure of treatment with cephalexin for Lyme disease. Arch Fam Med, 9(6), 563-567 (2000).
- Plotkin SA. Correcting a public health fiasco: The need for a new vaccine against Lyme disease. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 52 Suppl 3, s271-275 (2011).
- Brinar VV, Habek M. Rare infections mimicking MS. Clin Neurol Neurosurg, (2010).
- Calabresi PA. Diagnosis and management of multiple sclerosis. Am Fam Physician, 70(10), 1935-1944 (2004).
- Trojano M, Paolicelli D. The differential diagnosis of multiple sclerosis: classification and clinical features of relapsing and progressive neurological syndromes. Neurol Sci, 22 Suppl 2, S98-102 (2001).
- Fallon BA, Keilp JG, Corbera KM et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology, 70(13), 992-1003 (2008).
- Paparone PW. Polymyalgia rheumatica or Lyme disease? How to avoid misdiagnosis in older patients. Postgrad Med, 97(1), 161-164, 167-170 (1995).
- Schwartzberg M, Weber CA, Musico J. Lyme borreliosis presenting as a polymyalgia rheumatica-like syndrome. Br J Rheumatol, 34(4), 392-393 (1995).
- Jennings F, Lambert E, Fredericson M. Rheumatic diseases presenting as sports-related injuries. Sports Med, 38(11), 917-930 (2008).
- Cameron DJ. Consequences of treatment delay in Lyme disease. J Eval Clin Pract, 13(3), 470-472 (2007).
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Clinical Takeaway
Lyme disease misdiagnosis occurs in 30-50% of initial presentations due to symptom overlap with autoimmune, neurologic, and psychiatric conditions. Key challenges include unreliable two-tier testing (30-50% false negatives in early disease), non-endemic physician bias, and psychiatric misattribution of neuroborreliosis symptoms. Diagnostic delays average 1-3 years, with some patients enduring 5-10 years of incorrect diagnoses before receiving proper Lyme testing and treatment.
Frequently Asked Questions
What diseases is Lyme most commonly misdiagnosed as?
Multiple sclerosis, fibromyalgia, chronic fatigue syndrome, rheumatoid arthritis, lupus, ALS, and psychiatric disorders including depression and anxiety.
Why do doctors miss Lyme disease?
Unreliable testing (30-50% false negatives), lack of training outside endemic areas, symptom overlap with dozens of conditions, and geographic bias that assumes Lyme only occurs in certain regions.
Can Lyme disease cause MS-like symptoms?
Yes. Lyme neuroborreliosis can cause weakness, numbness, vision problems, balance issues, and brain lesions on MRI—symptoms nearly identical to multiple sclerosis.
How long does it take to diagnose Lyme disease correctly?
Average diagnostic delay ranges from 1-3 years from symptom onset. Some patients endure 5-10+ years of misdiagnosis before receiving proper Lyme testing and treatment.
What should I do if I think I’ve been misdiagnosed?
Request Lyme testing regardless of your location, seek evaluation from a Lyme-literate physician, and don’t accept psychiatric diagnosis without first ruling out infectious causes.