- Erythema migrans (EM) rash at the site of a tick bite, often near skin folds such as the armpit, groin, or back of the knee, on the trunk, under clothing straps, or in children's hair, ears, or neck.
- The rash is usually circular or oval, red or bluish, and may have an elevated or darker center.
- The rash gradually clears from the center toward the edges, possibly forming a "bull's eye" pattern.
- The rash may feel warm, but usually is not itchy, is rarely tender or painful, and takes up to four weeks to resolve if untreated.
- Fatigue, headache, body aches, fever, and chills, but usually not nausea or upper-respiratory problems.
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- Transient muscle pains and joint pains
- In 10–15% neuroborreliosis such as:
- Lymphocytic meningitis: Inability to flex the neck fully and intolerance to bright lights but typically no or only very low fever.
- Cranial neuritis: Facial palsy, impairing blinking, smiling, and chewing on one or both sides of the face. It may also cause intermittent double vision.
- Radiculopathy: Pain and less often weakness, numbness, or altered sensation in the areas of the body served by nerves connected to the affected roots, e.g. limb(s) or part(s) of trunk. The pain is often described as unlike any other previously felt, excruciating, migrating, worse at night, rarely symmetrical, and often accompanied by extreme sleep disturbance.
- Mononeuritis multiplex. causing similar symptoms to Radiculopathy in one or more unrelated peripheral nerves
- Up to 76.5% tinnitus
- Vertigo and dizziness (53.7%) and hearing loss (16.7%) were the next most common symptoms.
- In children partial loss of vision
- Rarely, confusion, abnormal gait, ocular movements, or speech, impaired movement, impaired motor planning, or shaking.
- 0.3–4% Lyme carditis. Symptoms may include heart palpitations, dizziness, fainting, shortness of breath, and chest pain.
- Borrelial lymphocytoma, a purplish lump that develops on the ear lobe, nipple, or scrotum.
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- Lyme arthritis occurs in up to 60% of untreated people, usually affects only one or a few joints, often a knee or possibly the hip, other large joints, or the temporomandibular joint. Usually, large joint effusion and swelling occur, but only mild or moderate pain. Without treatment, swelling and pain typically resolve over time, but periodically return. Baker's cysts may form and rupture.
- Rare peripheral neuropathy was described that included numbness, tingling, or burning starting at the feet or hands and over time possibly moving up the limbs.
- Lyme encephalopathy is associated with
- Subtle memory and cognitive difficulties
- Insomnia, a general sense of feeling unwell
- Changes in personality.
- Problems such as depression and fibromyalgia are as common in people with Lyme disease as in the general population.
- There is no compelling evidence that Lyme disease causes psychiatric disorders, behavioral disorders (e.g. ADHD), or developmental disorders (e.g. autism).
- Acrodermatitis chronica atrophicans is a chronic skin disorder observed primarily in Europe among the elderly. It begins as a reddish-blue patch of discolored skin, often on the backs of the hands or feet. The lesion slowly atrophies over several weeks or months, with the skin becoming first thin and wrinkled and then, if untreated, completely dry and hairless. It is also associated with peripheral neuropathy.
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