A Lyme Neuroborreliosis Case Presenting With Ophthalmoplegia, Dysarthria, and Spastic Quadriparesis

Lyme neuroborreliosis (LNB) represents the neurological manifestation of Lyme disease and is the most common form of disseminated Lyme infection in Europe. Central nervous system involvement in LNB includes cranial neuritis, meningitis, radiculoneuritis, encephalitis, and encephalomyelitis with quadriparesis. We report a patient presenting with complex ophthalmoplegia, speech impairment, and spastic quadriparesis. The neurological weakness initially followed an ascending pattern suggestive of Guillain-Barré syndrome (GBS). Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis, and serum testing showed positivity for immunoglobulin G (IgG) antibodies to Borrelia P39 and variable major protein-like sequence expressed (VlsE) antigens. IgG and immunoglobulin M (IgM) immunoblots were also positive. The patient was initially treated with intravenous immunoglobulin (IVIG) for presumed GBS and subsequently received antibiotics following CSF findings indicative of central nervous system infection, with subsequent neurological improvement. This case highlights the diagnostic challenges of LNB and underscores the importance of thorough evaluation of clinical history, neurological examination, and laboratory investigations to achieve diagnostic accuracy.