Late disease manifestations

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

Reference:

• (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