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Lyme disease is a multisystem infection caused by the spirochete Borrelia burgdorferi sensu stricto that manifests with characteristic symptoms in patients. Patients are identified based on their clinical symptoms and then diagnosed through enzyme-linked immunosorbent assay (ELISA), Western blot, and blood culture techniques. Here, we present the case of a 75-year-old, Northeast suburban resident complaining of unstable gait, high fevers, malaise, myalgia, and confusion. This patient’s symptoms were nonspecific, and his lab titers and blood cultures were repeatedly negative during his stay. It was only late in the course of his treatment that blood titers and cerebrospinal fluid analysis were positive for Lyme IgG and IgM. He was treated with intravenous doxycycline and prescribed oral doxycycline on discharge, resulting in a full recovery. We express the need for physicians to consider Lyme disease in endemic patients presenting with nonspecific systemic signs.

We describe a previously healthy young man who presented with headaches, diplopia with right lateral gaze palsy, dysphagia, and hoarseness over a 2-month period. Magnetic resonance imaging of the brain revealed a small enhancing mass at the prepontine cistern and chest CT showed a left mediastinal mass. Mediastinoscopy and lymph node biopsy were performed. DNA probe and culture of the biopsy specimen were confirmed to be Mycobacterium tuberculosis complex. Resolution of neurologic symptoms was noted after 6 weeks, in addition to regression of brain stem and mediastinal lesions after 12 weeks of antituberculous therapy.