Guillain-Barré Syndrome as the Initial Manifestation of Lyme Disease: Diagnostic Challenges

Lyme disease is a common tick-borne infection in the United States and Europe that may involve the nervous system during the disseminated stage. Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy usually triggered by infection; however, its association with Borrelia burgdorferi is uncommon and can pose diagnostic challenges. We report the case of a previously healthy 61-year-old female patient who presented with progressive ascending weakness and areflexia suggestive of GBS. During hospitalisation, she developed bilateral facial nerve palsy, prompting further evaluation. Cerebrospinal fluid (CSF) findings and electrophysiological studies supported acute inflammatory demyelinating polyneuropathy, while serologic testing confirmed Lyme disease. The patient received intravenous immunoglobulin (IVIG) followed by intravenous ceftriaxone and achieved complete neurological recovery. This case emphasises the need to consider Lyme disease in patients presenting with acute inflammatory neuropathy, particularly in endemic regions, as early diagnosis and targeted therapy can significantly improve outcomes.