A Rare Case of Lyme Neuroborreliosis Presenting as Bannwarth Syndrome in Texas

Lyme disease is a spirochete infection acquired after inoculation of Borrelia burgdorferi with the bite of an Ixodes tick, commonly encountered in the Northeastern United States, usually characterized by erythema migrans, arthritis, and meningitis. Bannwarth syndrome is an uncommon manifestation of Lyme neuroborreliosis (LNB) in the United States. It can present with various clinical features, which often make the diagnostic process challenging. In our case, the subacute onset of flaccid leg weakness with diminished deep tendon reflexes and facial weakness mimicked Guillain-Barré syndrome (GBS). Physicians need to be aware of the rare neurological manifestations of Bannwarth syndrome, especially in non-endemic areas such as Texas. Here we present a rare case of Lyme neuroborreliosis (LNB) manifesting as a painful meningoradiculitis (Bannwarth syndrome) with radicular pain, paresis, and cranial nerve involvement in Texas.