Focal encephalitis in a young woman 6 years after the onset of Lyme disease: tertiary Lyme disease?

A 19-year-old woman had severe focal inflammatory encephalitis. Six years previously, she had had classic untreated Lyme disease characterized by erythema chronicum migrans, bilateral facial palsies, and lymphocytic meningitis. During her recent encephalitic illness, Lyme disease serologic tests were positive by indirect immunofluorescence microscopy, enzyme-linked immunosorbent assay, and western blot (immunoblot technique) testing. We hypothesize that the patient's focal inflammatory encephalitis was a result of a persistent spirochetal infection of the central nervous system.