Erythema migrans associated with partial Horner's syndrome

Lyme disease is a tick-borne illness caused mainly by three species of spirochaete Borrelia--B. burgdorferi, B. afzelii and B. garinii. It has three stages of presentation--early localised, early-disseminated and late Lyme. Erythema migrans is the most common manifestation of Lyme disease, and is usually seen 7-14 days after the tick bite. Patients seldom remember the tick bite. Patients may often present with neurological manifestations indicating neuroborreliosis. These manifestations range from a simple nerve palsy to severe complications such as papilloedema, myelitis or meningitis. We present a case of a 37-year-old woman who presented with partial Horner's syndrome, which was associated with erythema migrans, and other signs of Lyme disease.