Many people associate Lyme disease with a classic rash that resembles a bull’s-eye. While this occurs often, a person may also develop less common symptoms associated with the disease.

Lyme disease is a tick-borne illness. In many cases, it causes a rash to appear on the skin, which is a classic sign of infection. Less commonly, a person may develop additional symptoms and complications that can be serious and even life threatening.

This article reviews Lyme disease, its common and unusual symptoms, complications, and more.

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Lyme disease spreads through black-legged tick bites. It is the most common vector-borne disease in the United States. A vector-borne disease spreads through blood-feeding insects such as mosquitoes and ticks.

Most cases of Lyme disease result from a person contracting the bacteria Borrelia burgdorferi. However, in rare cases, it may be the result of Borrelia mayonii. A doctor can diagnose Lyme disease based on common symptoms and confirm the diagnosis with lab tests.

Following diagnosis, doctors typically treat the disease with antibiotics.

A person can take steps to help prevent Lyme disease, such as:

  • reducing tick habitats around homes
  • applying pesticides
  • using insect repellents
  • removing ticks before they attach to the skin

Learn how to identify types of ticks here.

Lyme disease can produce different symptoms and signs in its early stages.

According to the Centers for Disease Control and Prevention (CDC), some common early signs of Lyme disease include:

Many people associate Lyme disease with an erythema migrans rash, which resembles a bull’s-eye or target. However, the CDC notes that a rash may not occur in 20–30% of all Lyme disease cases. It also may not appear as the classic bull’s-eye shape that people often expect.

Below are some less common symptoms that a person with Lyme disease may experience.

Aches and pains

Lyme disease can cause arthritis-like pain in the joints in its early stages. The difference between Lyme disease and arthritis is that Lyme disease affects one joint for a short amount of time and then moves to another joint.

In more advanced, untreated Lyme disease, joint pain can turn into intermittent arthritis. In rare cases, a person may develop severe chronic arthritis linked to the immune system’s response to the infection.

Without prompt treatment, arthritis can cause permanent joint damage.

Visual, auditory, and sensory symptoms

If the bacteria that causes Lyme disease moves into the central nervous system, it can cause sensory issues. This can include sensitivity to light as well as other visual disturbances.

In some cases, Lyme disease can cause auditory (hearing) issues. According to a 2021 study, Lyme disease may contribute to the development of lesions that may cause sudden sensorineural hearing loss.

The researchers noted that people with long-duration infections were more likely to experience permanent and irreversible changes in the cochlea or auditory nerve.

Cognitive, neurological, and psychological symptoms

Lyme disease can cause cognitive, neurological, and, in some cases, psychological symptoms. It can affect the central, cranial, and peripheral nervous systems.

When the bacteria affect the nervous systems, it can cause neurological symptoms. They can include:

  • Central nervous system: This may cause sensitivity to light, issues with vision, stiff neck, fever, or headache.
  • Cranial nervous system: This may cause facial palsy, which is drooping facial features on one or both sides of the face.
  • Peripheral nervous system: This may cause tingling or numbness, a sharp, shooting pain, and weakness in the arms or legs.

The symptoms can often resemble those of other disorders, which could lead to misdiagnosis.

Learn more about neurologic Lyme disease here.

Left untreated, Lyme disease can affect several areas of the body, including the central nervous system and heart.

Lyme carditis occurs when the bacteria enter the heart tissue. This causes disturbances in how electrical signals move throughout the heart, which can cause several symptoms, including:

The bacteria enter the heart in about 1 out of every 100 cases of Lyme disease. This complication can be life threatening, with 11 reported deaths between 1985–2019 worldwide.

The following are answers to questions about Lyme disease.

What might a doctor misdiagnose Lyme disease as?

Ticks can carry a variety of different organisms and diseases with them.

The lone star tick can carry a disease known as southern tick-associated rash illness. The rash it causes looks very similar to a Lyme disease rash. In addition, it can cause similar symptoms to Lyme disease, including fever, fatigue, joint and muscle aches, and headache.

What are the symptoms of chronic Lyme disease?

Chronic Lyme disease is not a recognized condition. However, some symptoms can persist past treatment. This has led doctors to describe the phenomenon as post-treatment Lyme disease syndrome (PTLDS). PTLDS occurs in about 5–20% of people who receive Lyme disease treatment. It may cause symptoms such as:

The exact cause is unknown. However, it may be due to persistent infection, immune system activation, damage from Lyme infection, or changes in the brain following Lyme disease.

In most cases, a doctor can treat Lyme disease with a round of antibiotics. The CDC notes that early treatment is important, as it can help prevent late Lyme disease from occurring, which can cause complications.

Treatments can vary based on the different types of Lyme disease. They typically involve the use of antibiotics to cure the infection.

In some cases, a person may develop PTLDS. While the CDC acknowledges that this can occur, it also notes that additional research is necessary to understand the biological mechanisms involved.

Lyme disease can cause a variety of symptoms. A person can reduce their risk of contracting Lyme disease by taking steps such as using insect repellent or pesticides.

If a person suspects Lyme disease may be causing symptoms, or has found a tick attached to their skin, they should contact their doctor for testing. Treating Lyme disease early can help prevent more serious, less common symptoms and complications associated with the infection.