Unusual Symptoms of Lyme Disease To Watch For

Knowing the less common symptoms can help diagnose Lyme disease early on when it's easily treatable.

A bull's-eye rash is characteristic of Lyme disease, but some people may have more unusual symptoms that affect the brain, eyes, heart, and skin. A healthcare provider can diagnose Lyme disease based on your symptoms, whether you have had a recent tick exposure, and lab test results. In addition to a rash, other early symptoms typically include a fever, headache, and muscle and joint pain.

Nearly 20% to 30% of people develop Lyme disease without a rash, so it's essential to know how else the tick-borne illness can manifest. Read on to learn what the unusual symptoms of Lyme disease are and when to see a healthcare provider.

Person hiking in forest passes tick warning sign.

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What Is Lyme Disease?

Lyme disease is an infection caused by the bacteria Borrelia burgdorferi. The bacteria is spread through the bites of infected blacklegged ticks (deer ticks). Nymphs, which are young, immature ticks, are most likely to transmit Lyme disease. Blacklegged ticks are typically found in the Northeastern, West North Central, and Northwestern United States in grassy, wooded areas.

Common Symptoms

Chances are you have no idea an infected tick has bitten you until symptoms surface. Ticks secrete an anesthetic that makes their bites painless, Christine Green, MD, director of education at the International Lyme and Associated Disease Society, told Health. You might also not even notice a nymph, roughly the size of a pinhead, when it latches on.

The incubation period, or the time between your exposure to Borrelia bacteria and symptom onset, ranges from three to 30 days. Within that time, you might notice early symptoms like:

  • Fever and chills
  • Headache
  • Malaise, or generally feeling sick
  • Muscle and joint pain
  • Rash
  • Stiff neck

Lyme Disease Rash

As many as 80% of people with Lyme disease develop erythema migrans (EM), a type of rash. The rash takes about seven days to develop and often quickly expands up to 12 inches or more. You might develop more than one rash as the infection spreads. It's entirely possible to have Lyme disease without a rash, or at least one that you do not notice at the time.

The characteristic "bull's-eye" rash is typically circular or oval. The rash typically appears red in people with lighter skin tones. People with darker skin tones might have less obvious rashes that appear dark and purplish with a central clearing.

The bull's-eye rash is just one of several different ways EM can present, Timothy Flanagan, MD, a professor of medicine at Brown University, told Health. You might have a red rash with crusting in the middle or a bluish-purple lesion.

EM can appear almost anywhere on the body, generally at or near the spot where the tick bites you. Ticks can settle in skin folds, such as the armpits and groin. Ticks may hide in your hair or attach to areas you cannot see or reach, like your back.

Unusual Symptoms of Lyme Disease

Lyme disease symptoms can be vague and vary from person to person. Some people develop uncommon symptoms that affect the brain, eyes, heart, and skin.

1. Lyme Carditis

Lyme carditis happens if Borrelia bacteria enter the tissues of the heart. This rare complication causes symptoms like:

  • Chest pain
  • Fainting
  • Heart palpitations
  • Lightheadedness
  • Difficulty breathing and shortness of breath

2. Neurological Symptoms

The longer Borrelia bacteria linger in your body, the more they spread. That bacteria can trigger neurological symptoms, such as:

  • Bell's palsy, which causes partial paralysis or weakness of the face
  • Intracranial hypertension, or increased pressure around the brain that causes severe headaches and vision changes
  • Lymphocytic meningitis (inflammation of the brain and spinal cord), which causes a stiff neck, fever, and headache
  • Nerve damage (e.g., pain, numbness, or tingling in the hands and feet)

Research has found that Lyme disease symptoms can also manifest as mental health issues. For example, some people with the tick-borne illness develop anxiety or depression.

3. Skin Changes

If untreated, Lyme disease may cause additional EM rashes on your arms, face, and legs. You might notice small, oval-shaped rashes or a bluish-red lump (borrelial lymphocytoma) around the nipples. Those lumps often appear on the earlobes in children.

Late-stage Lyme disease might cause skin changes, such as redness and swelling. Your skin might harden, shrinken, and form deep lines.

An untreated bacterial infection might result in cutaneous B-cell lymphoma (CBCL), a rare type of cancer that causes tumors on the skin. Those tumors appear as dark pink or red lesions in people with lighter skin tones. CBCL might be difficult to notice in people with darker skin tones since the tumors often appear as skin-colored nodules.

4. Vision Changes

Research has shown that conjunctivitis (pink eye) and inflammation of the different parts of your eye are uncommon symptoms of Lyme disease. Other vision problems may include:

  • Blurry vision
  • Double vision
  • Loss of color vision
  • Photophobia, or a sensitivity to light

How Is Lyme Disease Diagnosed?

A healthcare provider can diagnose Lyme disease based on your symptoms and recent tick exposure. They will likely collect a blood sample to test for antibodies to Borrelia bacteria. Of note: A blood test may be inconclusive if you receive it during the earliest stages of illness.

Other diagnostic tests that help confirm or rule out late-stage Lyme disease include:

  • Brain MRI: Takes detailed pictures of your brain
  • Echocardiogram: Uses sound waves to create detailed pictures of your heart.
  • Electrocardiogram (ECG): Checks your heart's electrical activity.
  • Lumbar puncture (spinal tap): Checks your cerebrospinal fluid (CSF), which cushions your brain and spinal cord, for signs of an infection

A healthcare provider usually uses those tests if you show symptoms of late-stage Lyme disease. Early-stage illness typically causes mild flu-like symptoms. In contrast, symptoms may involve other body parts—including the brain, eyes, heart, and skin—during later stages.

Treatments for Lyme Disease Symptoms

The sooner you notice symptoms, the better your outcome. Treatment during the early stages of Lyme disease increases the chances of a full, rapid recovery.

A short course of an oral antibiotic, such as doxycycline or amoxicillin, can clear up symptoms in most cases. The exact drug, dosage, and duration a healthcare provider prescribes depends on factors like your age and health history.

According to Dr. Flanagan, other steps you can take to help your body recover and reduce inflammation include:

  • Get plenty of restorative sleep.
  • Regularly exercise.
  • Take nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen).
  • Use topical creams.

Long-Term Symptoms

After treatment, some people report lingering symptoms, such as fatigue, pain, and muscle and joint aches. Symptoms that persist for more than six months may lead to post-treatment Lyme disease syndrome (PTLDS). This is known as "chronic Lyme disease" among certain patient communities. No data suggests these symptoms are due to persistent bacterial infection. People with PTLDS get better in time, but it can take months.

A healthcare provider might recommend prolonged antibiotic treatment. Still, experts caution against a long-term course of antibiotics, which can be dangerous and unhelpful.

Complications

Lyme disease may cause complications if it progresses to later stages or remains untreated. Possible complications include:

  • Heart rhythm problems
  • Lyme arthritis, or long-term joint inflammation
  • Memory problems
  • Nerve damage 
  • Numbness
  • Pain
  • Paralysis and weakness of the face
  • Sleep disorders
  • Trouble concentrating
  • Vision changes

When To Contact a Healthcare Provider

Talk to a healthcare provider right away if you think you have symptoms of Lyme disease, such as a bull's-eye rash, or another tick-borne illness. They can help you best treat the illness and manage ongoing symptoms.

See a healthcare provider right away if you have had a tick bite and develop:

  • Heart problems
  • Numbness
  • Tingling
  • Weakness

Babesiosis can present alongside Lyme disease. This infection of red blood cells may cause life-threatening symptoms. A number of babesiosis symptoms (e.g., fever, fatigue, headache) are similar to Lyme disease, so it's essential to see a healthcare provider. They can help confirm or rule out what's going on.

A Quick Review

Early Lyme disease symptoms typically resemble the flu and include fever, headache, and muscle and joint pain. Many people also develop a distinct bull's eye rash where the tick bit them. In contrast, some people have more unusual symptoms that affect the brain, eyes, heart, and skin.

See a healthcare provider if you have had a recent tick exposure. Early diagnosis and treatment with antibiotics help reduce your risk of complications and long-term health effects. 

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Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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