Diagnostic Challenges of Lyme Co-infections: Lessons From a Lyme and Herpes Simplex Virus-1 (HSV-1) Cocktail

Abstract

Lyme borreliosis (LB) is a complex tick-borne illness with diverse presentations. We report a case of LB meningitis with herpes simplex virus-1 (HSV-1) co-infection in a 55-year-old woman initially presenting with isolated facial nerve palsy. This case illustrates the multifaceted diagnostic challenges associated with Lyme co-infections. It emphasizes the need for thorough testing to identify all potential pathogens and the importance of differentiating between true co-infection and incidental HSV-1 reactivation. Understanding these complexities is crucial for guiding appropriate treatment decisions.

Keywords: bell's palsy; co-infection; diagnostic challenge; facial palsy; hsv-1; lyme disease; misdiagnosis.

Figure 1. MRI of the brain w/ and w/o contrast

T2-weighted MRI of the brain image with and without contrast reveals thickening of the dura mater (long arrowhead), suggesting inflammation. Additionally, nonspecific white matter hyperintensities are seen bilaterally in the parietal lobes (short arrowheads).

Figure 2. MRI of the brain w/ and w/o contrast

T2-weighted MRI of the brain image highlights leptomeningeal enhancement (circled), a sign of meningeal inflammation.