Can a Tick Bite Lead to Guillain-Barré Syndrome?
Guillain-Barré syndrome can rarely follow a tick-borne infection.
Lyme neuroborreliosis may also resemble Guillain-Barré syndrome.
Progressive weakness requires urgent neurologic evaluation.
Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, I discuss the case of a 71-year-old woman who was initially diagnosed with ehrlichiosis after a tick bite and later developed Guillain-Barré syndrome (GBS), a rare but potentially life-threatening neurologic complication.
Can a tick bite lead to Guillain-Barré syndrome? Rarely, Guillain-Barré syndrome has been reported following tick-borne infections such as ehrlichiosis and Lyme disease. However, the relationship is not always straightforward. In some patients, an infection may precede an immune-mediated neuropathy, while in others, Lyme neuroborreliosis may produce symptoms that resemble Guillain-Barré syndrome.
Guillain-Barré syndrome is an acute immune-mediated disorder affecting the peripheral nerves. It typically presents with rapidly progressive weakness, decreased or absent reflexes, numbness, tingling, and difficulty walking. Severe cases may also affect swallowing, bladder function, heart rate, blood pressure, or breathing.
Because several neurologic disorders can resemble Guillain-Barré syndrome, patients who develop progressive weakness after a tick bite require a broad diagnostic evaluation rather than assuming a single condition explains every symptom.
A woman developed Guillain-Barré syndrome after ehrlichiosis
The study, entitled Case of ehrlichiosis induced Guillain-Barre Syndrome in a 71-year-old female, was published by Malhis and colleagues in the journal IDCases.1
The woman’s illness developed over approximately three weeks and included generalized weakness, dizziness, visual changes, chills, fever, neck pain, and abdominal pain.
After presenting to the hospital, physicians diagnosed ehrlichiosis based on thrombocytopenia, elevated liver enzymes, a history of an insect bite, a positive Ehrlichia PCR test, and the absence of another identified illness.
She was treated with doxycycline, and her initial symptoms improved.
Watch the discussion below
Listen to the podcast
Approximately one week later, however, she returned to the hospital with worsening neurologic symptoms.
The authors reported that she developed numbness and areflexia in her lower extremities that had progressed since her first hospital encounter. She developed an unsteady gait requiring a walker, tingling in her feet, and urinary retention that required straight Foley catheterization.
She was diagnosed with acute inflammatory demyelinating polyradiculoneuropathy (AIDP), the most common form of Guillain-Barré syndrome.
Testing found no evidence of another tick-borne illness, including Lyme disease, babesiosis, Heartland virus infection, or Bourbon virus infection.
The patient improved significantly after treatment with intravenous immunoglobulin (IVIG) and was discharged to a rehabilitation center.
“Although ehrlichiosis is not a common cause for GBS, the pathogenesis is like Lyme disease or Campylobacter jejuni,” the authors wrote.
The investigators emphasized that patients whose neurologic symptoms worsen despite treatment for a tick-borne illness require an expanded differential diagnosis.
How can an infection be followed by Guillain-Barré syndrome?
Guillain-Barré syndrome is generally considered an immune-mediated neuropathy rather than a direct infection of the peripheral nerves.
Most cases occur after a respiratory or gastrointestinal infection. Campylobacter jejuni is the best-recognized trigger, but GBS has also been associated with cytomegalovirus, Epstein-Barr virus, influenza, HIV, Zika virus, and several other infections.
One proposed mechanism is molecular mimicry. Components of an infectious organism may resemble structures on peripheral nerves, causing the immune system to mistakenly attack myelin or nerve axons.
When GBS develops after a tick-borne infection, it may be difficult to determine whether the infection triggered an immune-mediated neuropathy, directly affected the nervous system, or simply occurred at the same time.
Can Lyme disease be associated with Guillain-Barré syndrome?
Although uncommon, published case reports and case series have described Guillain-Barré syndrome occurring in association with Lyme disease in both adults and children.4–10
Some reports describe patients with evidence of Lyme disease and electrodiagnostic or cerebrospinal fluid findings consistent with acute inflammatory demyelinating polyneuropathy. Others describe Lyme neuroborreliosis producing a Guillain-Barré-like illness that improved following antibiotic therapy.
A 2022 case report described a 65-year-old man with progressive weakness, respiratory failure, albuminocytologic dissociation, and electrodiagnostic findings consistent with an acute demyelinating neuropathy. Lyme testing supported early disseminated Lyme disease, and he was treated with IVIG and antibiotics.4
A 2023 report described a 33-year-old man with ascending weakness, sensory symptoms, bilateral facial palsy, nerve-root enhancement, and electrodiagnostic evidence of demyelination. His condition worsened despite IVIG for presumed Guillain-Barré syndrome. Lyme antibodies were later identified in serum and cerebrospinal fluid, and he improved after treatment with ceftriaxone and doxycycline for neuroborreliosis.5
More recent reports have described adults with progressive weakness, areflexia, facial palsy, and laboratory evidence of Lyme disease who were treated with both IVIG and ceftriaxone when overlap between Guillain-Barré syndrome and Lyme neuroborreliosis could not be confidently excluded.6,7
A 2026 pediatric case report described a 13-year-old girl with Lyme neuroborreliosis and a sensorimotor demyelinating neuropathy diagnosed as Guillain-Barré syndrome. She received treatment for both conditions along with rehabilitation and was able to walk with support seven months later.8
These reports support an association but do not establish that Lyme disease is a common or definitive cause of Guillain-Barré syndrome. They also illustrate the diagnostic challenge of distinguishing true postinfectious Guillain-Barré syndrome from Lyme polyradiculitis or neuroborreliosis that produces a similar clinical picture.
Lyme neuroborreliosis can resemble Guillain-Barré syndrome
Lyme neuroborreliosis and Guillain-Barré syndrome may share several clinical features, including progressive weakness, decreased reflexes, facial nerve palsy, radicular pain, sensory symptoms, elevated cerebrospinal fluid protein, and abnormalities on nerve conduction studies.
Lyme disease more commonly affects the peripheral nervous system through cranial neuropathy, meningitis, radiculoneuritis, or polyradiculitis than through classic Guillain-Barré syndrome.
A child reported by Kumar and colleagues initially appeared to have Guillain-Barré syndrome based on weakness, areflexia, cranial nerve involvement, elevated cerebrospinal fluid protein, and nerve-conduction abnormalities. Further history revealed a preceding insect bite and local skin reaction. Lyme testing was positive, and the final diagnosis was Lyme polyradiculitis.9
Another report described an adult whose unusual neurologic presentation raised competing possibilities of Guillain-Barré syndrome, Lyme neuroborreliosis, and functional neurologic symptoms. Additional testing and improvement following ceftriaxone supported neuroborreliosis as an important part of the diagnosis.10
This distinction is clinically important because Guillain-Barré syndrome is treated with IVIG or plasma exchange, whereas Lyme neuroborreliosis requires appropriate antibiotic therapy. When the conditions overlap or cannot be confidently distinguished, clinicians may treat both processes based on the patient’s presentation.
“`html
How is Guillain-Barré syndrome diagnosed?
No single test establishes the diagnosis in every patient. Physicians combine the clinical history, neurologic examination, cerebrospinal fluid findings, electrodiagnostic testing, and exclusion of alternative diagnoses.
Features supporting Guillain-Barré syndrome may include:
- Progressive weakness involving the arms and legs
- Decreased or absent deep tendon reflexes
- Symmetrical motor involvement
- Mild sensory symptoms compared with the degree of weakness
- Facial weakness or other cranial nerve involvement
- Autonomic dysfunction
- Respiratory muscle weakness
- Clinical progression over hours, days, or several weeks
A lumbar puncture may show albuminocytologic dissociation, meaning an elevated cerebrospinal fluid protein level with few or no white blood cells. However, this finding may be absent early in the illness and is not unique to Guillain-Barré syndrome.
Nerve conduction studies and electromyography may identify a demyelinating or axonal peripheral neuropathy. These studies can also help distinguish Guillain-Barré syndrome from other neurologic disorders.
Testing for Lyme disease, ehrlichiosis, and other tick-borne illnesses should be guided by the patient’s exposure history, geographic location, symptoms, physical findings, and laboratory results.
Clues that may suggest Lyme neuroborreliosis
Clinical findings that may increase concern for Lyme neuroborreliosis include:
- Known or possible exposure to ticks
- An erythema migrans or other compatible rash
- Facial nerve palsy, especially bilateral facial weakness
- Severe radicular pain
- Lymphocytic inflammation in the cerebrospinal fluid
- Headache or meningitis symptoms
- Positive Lyme serology interpreted in the clinical context
- Evidence of intrathecal antibody production when evaluated
The absence of a recognized tick bite does not exclude Lyme disease. Several reported patients with neurologic Lyme disease did not recall being bitten by a tick.
Likewise, positive Lyme antibodies alone do not prove that Lyme disease explains a patient’s neurologic syndrome. Test results must be interpreted together with the clinical presentation and other findings.
Tick paralysis can also resemble Guillain-Barré syndrome
Tick paralysis and Guillain-Barré syndrome can both produce progressive weakness after tick exposure, but they are different disorders.
Tick paralysis is caused by a neurotoxin released by an attached tick during feeding. The weakness may progress upward and become severe, but removal of the tick typically leads to improvement.
Guillain-Barré syndrome is an immune-mediated neuropathy that usually develops after an infection. Treatment typically requires IVIG or plasma exchange rather than tick removal alone.
A careful examination of the skin and scalp for an attached tick is therefore important in a patient with unexplained, rapidly progressive weakness.
How is Guillain-Barré syndrome treated?
The two principal disease-modifying treatments for Guillain-Barré syndrome are intravenous immunoglobulin and plasma exchange. These treatments are considered similarly effective when used appropriately.
IVIG provides pooled antibodies that help modify the abnormal immune response. Plasma exchange removes circulating antibodies and other inflammatory components from the blood.
Corticosteroids alone have not been shown to improve Guillain-Barré syndrome outcomes and are not considered standard treatment for the condition.
Supportive care may include:
- Frequent respiratory monitoring
- Mechanical ventilation when needed
- Monitoring for heart rate and blood pressure instability
- Prevention of blood clots and pressure injuries
- Pain management
- Bladder and bowel support
- Physical and occupational therapy
- Inpatient or outpatient rehabilitation
When Lyme neuroborreliosis or another bacterial tick-borne infection is identified, appropriate antimicrobial treatment may also be required.
What is the outlook for Guillain-Barré syndrome?
Many patients recover the ability to walk independently, although improvement may take weeks, months, or longer.
Recovery varies depending on the severity of nerve injury, the degree of respiratory or autonomic involvement, the patient’s age and overall health, and how quickly treatment and rehabilitation begin.
Some patients continue to experience weakness, fatigue, numbness, tingling, pain, balance problems, or reduced endurance after the acute illness.
The woman with ehrlichiosis described by Malhis and colleagues improved significantly after IVIG and was discharged to a rehabilitation center.1
Bourbon virus and other tick-borne illnesses
The original report also discussed the importance of considering newly recognized tick-borne infections when a patient does not improve with tetracycline treatment.
Kosoy and colleagues described a 50-year-old man from eastern Kentucky who had several tick bites, enlarged lymph nodes, a maculopapular rash, thrombocytopenia, leukopenia, nausea, vomiting, diarrhea, fever, muscle pain, headache, and joint pain.2
Testing was negative for known tick-borne pathogens, and the patient did not improve with tetracycline treatment.
“Multiorgan failure developed, and he died 11 days after illness onset from cardiopulmonary arrest,” the investigators reported.
Further investigation identified Bourbon virus, a rare tick-borne virus.2,3
Heartland virus and Bourbon virus are viral infections, so they would not be expected to respond to doxycycline or another antibacterial medication. Persistent deterioration despite appropriate antibiotic treatment should prompt physicians to reconsider the diagnosis and investigate other infectious and noninfectious conditions.
Inside Lyme Podcast Series
The following questions are addressed in this podcast episode:
- Can a tick bite lead to Guillain-Barré syndrome?
- How may ehrlichiosis be associated with Guillain-Barré syndrome?
- Can Lyme neuroborreliosis resemble Guillain-Barré syndrome?
- How are Guillain-Barré syndrome and Lyme polyradiculitis distinguished?
- What are Bourbon virus and Heartland virus?
- How is Guillain-Barré syndrome treated?
Thanks for listening to another Inside Lyme Podcast. Please remember that the information presented is general and is not intended as specific advice for any individual patient. Anyone who develops progressive weakness, difficulty walking, trouble swallowing, shortness of breath, or bladder dysfunction should seek urgent medical evaluation.
Inside Lyme Podcast Series
This Inside Lyme case series will be discussed on my Facebook page and made available as a podcast and on YouTube. As always, your likes, comments, and shares help spread the word about this series and our work. Please consider leaving a review on Apple Podcasts or wherever you listen to podcasts.
Frequently Asked Questions
Can a tick bite lead to Guillain-Barré syndrome?
Rarely, Guillain-Barré syndrome has been reported following tick-borne infections, including ehrlichiosis and Lyme disease. In some cases, the infection may precede an immune-mediated neuropathy. However, a tick bite by itself does not establish that the tick exposure led to Guillain-Barré syndrome.
Can Lyme disease be associated with Guillain-Barré syndrome?
Yes. Published case reports and case series have described Guillain-Barré syndrome occurring in patients with Lyme disease, but the association appears uncommon. Lyme neuroborreliosis can also produce weakness, areflexia, facial palsy, and radicular symptoms that resemble Guillain-Barré syndrome.
How can doctors distinguish Lyme neuroborreliosis from Guillain-Barré syndrome?
Doctors consider the pattern of weakness, cerebrospinal fluid findings, nerve conduction studies, Lyme testing, exposure history, rash, cranial nerve involvement, and evidence of inflammation. In some cases, the conditions overlap and cannot be separated with certainty at the beginning of the illness.
What symptoms require emergency evaluation?
Rapidly worsening weakness, inability to walk, difficulty swallowing, facial weakness, shortness of breath, a weak cough, bladder dysfunction, or rapidly spreading numbness requires immediate medical evaluation.
Is Guillain-Barré syndrome treatable?
Yes. IVIG and plasma exchange are the principal treatments. Respiratory monitoring, supportive care, and rehabilitation are also important. Antibiotic treatment may be needed when an active bacterial infection such as Lyme disease or ehrlichiosis is identified.
Clinical Takeaway
Guillain-Barré syndrome may rarely occur after a tick-borne infection, but Lyme neuroborreliosis can also produce a similar pattern of weakness, areflexia, cranial neuropathy, and nerve-root involvement.
Patients with progressive weakness after possible tick exposure require urgent neurologic evaluation and a broad differential diagnosis that may include Guillain-Barré syndrome, Lyme neuroborreliosis, ehrlichiosis, tick paralysis, spinal cord disease, and other infectious or immune-mediated disorders.
Recognizing the possibility of overlapping Guillain-Barré syndrome and tick-borne disease can help guide timely immunotherapy, antimicrobial treatment, respiratory monitoring, and rehabilitation.
Related Articles
Learn more about neurologic Lyme disease, diagnostic overlap, and related tick-borne conditions:
Lyme Disease Misdiagnosis
Autonomic Dysfunction in Lyme Disease
Persistent Lyme Disease Overview
Recovery From Lyme Disease
Lyme Disease Coinfections
References
- Malhis JR, Mahmoud A, Belote A, Ebers A. Case of ehrlichiosis induced Guillain-Barre Syndrome in a 71-year-old female. IDCases. 2021;26:e01301. doi:10.1016/j.idcr.2021.e01301.
- Shrestha K, Kadkhoda K. Early Lyme disease-associated Guillain Barre Syndrome: A case report. IDCases. 2022;27:e01432. doi:10.1016/j.idcr.2022.e01432.
- Farr J, Bittar J. Neuroborreliosis Presenting as Guillain-Barré Syndrome. Cureus. 2023;15(7):e42322. doi:10.7759/cureus.42322.
- Elnour A, Sultan N, Monem A, Ghalib K. Guillain-Barré Syndrome as the Initial Manifestation of Lyme Disease: Diagnostic Challenges. Cureus. 2026;18(3):e105552. doi:10.7759/cureus.105552.
- Baik J, Said M, Helmstetter N. Tick-Borne Infection as a Precipitant of Guillain-Barré Syndrome: A Case of Lyme Neuroborreliosis. Cureus. 2026;18(4):e106652. doi:10.7759/cureus.106652.
- Anghelina L, Radu L, Trăistaru MR, et al. Guillain–Barré Polyradiculoneuritis Developed in the Context of Lyme Neuroborreliosis in a 13-Year-Old Girl: A Case Report. Children (Basel). 2026;13(4):522. doi:10.3390/children13040522.
- Kumar M, Singh R, Rashid M. Lyme polyradiculitis masquerading Guillain-Barre syndrome. J Pediatr Neurosci. 2016;11(4):384-385. doi:10.4103/1817-1745.199483.
- Teodoro T, Oliveira R, Afonso P. Atypical Lyme Neuroborreliosis, Guillain-Barré Syndrome or Conversion Disorder: Differential Diagnosis of Unusual Neurological Presentations. Case Rep Neurol. 2019;11(1):142-147. doi:10.1159/000499901.
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 have personally seen this in someone post-vaccine.
It seems as though many are experiencing extremely similar symptoms after having Lyme, Covid and post vaccine. Long Covid, Chronic Lyme and Post vaccine injury are almost symptomatically identical.
What is the common denominator here?
In the mid-70s, I had a neighbor contract GBS associated with a viral infection. In the early 80s, as my undiagnosed condition spread throughout my body, I noted how similar it was to her description of the GBS onset…moving from extremities towards the trunk. It took 37 years to diagnose Lyme/Bartonella with multi-viral reactivation. I still remember how each new flare-up would introduce “whatever it was” to a new muscle/joint complex, then die down to embers until new stress or source of fatigue would start the process in a new area. It took 8 years to fully envelop the musculoskeletal system, then was present but subdued until 2017 when multi stressors led to an immune collapse. Multiantibiotic treatment plus several herbals are showing progress, but this latest flare damaged brain function more noticeably. Someday someone will find the common links.
I was Lymes- sick in June of 2020 while in Maine for the summer. I developed big circular rashes all over my body not bull-eyes. I had a fever as high as 103 up and down. This lasted about a week, my head ached, I vomited when my fever was the highest. I had body violently shaking with chills. When the rash hadn’t gone away after 2 weeks I went to a walk-in. Covid was new then and we tried to stay away from places like that. I’d had a test while I was sick which was negative for Cobid. The PA at the clinic took a look at my rashes asked me where I hurt that was new, I told her my knees, my neck. She diagnosed me with Lymes sickness and prescribed 3 weeks of Doxycycline. By late July early August I was still feeling fatigued more than my normal and just ached all over. We found a NP who was very LL because she’d had it herself. She became our most caring practitioner. Without all the details in between, I was getting worse we had headed back to Florida for the winter. I’m getting more fatigued and had very little energy to walk and it was becoming more difficult. I had some very bad falls. I saw a quack in Florida stating he was LL but to a Lymie it doesn’t take long to realize when someone doesn’t understand Lymes and co-infection. My practioner in Maine had ordered Igenix Lymes testing in August and my results were: Positive for Borreliosis, Burgdorferi, Babesiosis and Mycoplasma. I gradually lost feeling in my hands and feet and my arms and legs. By January 2021 I was in bed. In April I made contact with the practitioner in Maine and begged her to please help me long distance. Seeing the lyme specialist in Florida had been a total waste of time . With her help and the supplements and tinctures made by an herbalist in Maine and a Compounding Pharmacy here in Florida for LDN, I had neck surgery on September 29th to fuse C-5 & 6, with a basket and screws around it. I have been in-patient re-hab following my surgery for 6weeks. Now I’m home I’ve regained feeling in my limbs and walking with help for short distances. I’m actually going to walk again.
Ik hoop dat dit vertaald kan worden. Ik vertelde het eerder. In 2016 had ik GBS, alle ledematen verlamd, inclusief nek en de ademhaling. Grove tremor/uitschieters aan armen en fijne over het hele lichaam. De volgende dag had ik een klauwhand en een slappe arm, 2 klapvoeten, heel zwakke benen, romp, armen, nek en slikstoornissen. Ademhaling was nog steeds slecht en daarbij witte tenen en vingers. Die avond ervoor, acuut verlamming, waren mijn vingers halfblauw en kon bijna niet meer praten. Dr. Daniël heeft gelijk, het is een gevolg van diverse oorzaken en geen auto immuunziekte. Het kan net als bij Covid, auto immuun reageren, net als bij long Covid. Ik ben na 4 maanden langzaam hersteld.
I told you before. In 2016 I had GBS, paralyzed all limbs, including neck and breathing. Coarse tremor/outliers on arms and fine all over body. The next day I had a claw hand and a limp arm, 2 foot drop, very weak legs, trunk, arms, neck and swallowing difficulties. Breathing was still bad with white toes and fingers. That night before, acutely paralyzed, my fingers were half blue and could barely speak. dr. Daniel is right, it is a result of various causes and not an autoimmune disease. It can react autoimmune, just like with Covid, just like with lung Covid. I have slowly recovered after 4 months. [translated with google]
BTDT. Tick exposure in New York, Vermont in 1995. Lyme and associated TBDs followed, misdiagnosed GBS, CIDP.
My insurer’s PCP, ID and Neuro gatekeepers followed IDSA Lyme Dx and TMT guidelines. I almost died. Had to self pay for IGENIX tests, IV antibiotics. Much improved now but still disabled, and battling multiple NHL cancers, jaw pain. I asked two insurers to reimburse my out of pocket costs. Won two court cases, lost 2 — the last in 9th Circ Appeals court. Some hate light and love darkness.
I was diagnosed with Guillain-Barre syndrome in March of 2023 with paralysis from waste down. Months later and 3 hospitals later my neurologist tested me foe epison barr and lyme both positive.
It’s been a horrible experience and I’m still recovering. It’s hard to work. Walk my dogs. Daily tasks. Plus I went through both hurricanes in florida and suffered through this living in my truck w my 2 dogs.
I have patients with more than one condition. I have patients who are still ill after a neurologic condition who also have Lyme symptoms. Here is a published article where they treated both. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249767/
Diagnosis lyme disease after having been found unresponsive in hotel and woke out of 5 day coma only to become paralyzed 7 days later. It has not even been a year yet.