late disease manifestations

Last edited 05/2022

Late disease manifestations occur months or years later if the rash has been untreated. These include (1):

  • erosive arthritis:
    • rare in UK-acquired infection, common if the disease was acquired in North America or some parts of Europe (2)
    • mono- or oligoarticular
    • usually affects the knee (2)
    • intermittent or chronic
  • acrodermatitis chronica atrophicans
    • most common cutaneous manifestation seen in Europe
    • start off as an initial red or bluish-red discolouration which is followed by atrophic skin changes
    • usually seen on the extensor surfaces of the hands (3)
  • chronic progressive encephalitis and encephalomyelitis (rare). Lyme encephalitis can be differentiated from multiple sclerosis because of the presence of a specific antibody in the CSF and a higher cell count.
  • other features include cardiac involvement
    • during early disseminated infection, acute cardiac involvement may occur, characterized by atrioventricular conduction defects in varying degrees
    • less common cardiac manifestations include:
      • acute myopericarditis or,
      • more rarely, a dilated cardiomyopathy
    • Lyme carditis is potentially fatal if untreated (4)
  • and a dermatomyositis-like syndrome


  • (1) European Union Concerted Action on Lyme Borreliosis (EUCALB). Lyme borreliosis
  • (2) Health Protection Agency (HPA). Diagnosis and Treatment of Lyme borreliosis  
  • (3) National Travel Health Network and Centre (NaTHNaC) 2007. Travel Health Information Sheets: Lyme disease
  • (4) Kullber BJ et al. Lyme borreliosis: diagnosis and management.BMJ 2020;369:m1041