• Kaien Gu, Carl Boodman, Pamela Orr, and Terence Wuerz.
• Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Canada.
• Medicine (Baltimore). 2022 Nov 11; 101 (45): e31576e31576.

RationaleLyme disease is a tick-borne disease caused by the spirochete B. burgdorferi, and patients often present with symptoms comparable to a viral-like illness. The diagnosis can be challenging given its wide range of manifestations and diagnostic testing can take days or longer. Here, we present a case of Lyme disease presenting as brachial plexopathy and meningitis.Patient ConcernsA 76-years-old male presented to a tertiary-care hospital with left arm weakness and neck pain.DiagnosisOur patient was diagnosed with Lyme neuroborreliosis and had positive serology, including enzyme immunoassay and Western blot.InterventionsOur patient received 17 days of ceftriaxone (2g IV daily) followed by oral doxycycline (100mg bid).OutcomesOver the subsequent year, our patient had eventual complete recovery in muscle strength and sensation, with slower improvement to the cervical neck and left arm pain.LessonsIncidence of Lyme disease is increasing in North America, and the disease has a wide range of symptoms. Lyme neuroborreliosis (LNB) is 1 presentation and can present with early or late manifestations; clinicians should maintain a high index of suspicion and begin empiric treatment in individuals with a clinical syndrome consistent with LNB. Early LNB manifestations have onset within 6 months of infection and include cranial and peripheral neuropathy, radiculitis, and aseptic meningitis; late LNB encompasses a chronic encephalomyelitis.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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