Clinical Challenges and Delayed Diagnosis of Lyme Borreliosis in Non-Endemic Regions: A Case Series

Background Lyme borreliosis is the most common tick-borne disease in the Northern Hemisphere, with an expanding geographic distribution driven by climate change, environmental modifications, and increased human mobility. Despite its rising incidence, diagnosis remains challenging, particularly in non-endemic areas where clinical suspicion is low and presentations are often atypical. Case presentation We describe three cases of Lyme borreliosis presenting with cutaneous manifestations after travel to endemic regions. In all patients, diagnosis was delayed due to non-specific symptoms or misinterpretation of early findings. Serological testing confirmed infection, and treatment with doxycycline resulted in complete clinical resolution. Conclusions These cases underscore the importance of a careful travel history assessment, recognition of atypical clinical presentations, and maintaining a high index of suspicion for Lyme disease, even in regions traditionally considered non-endemic.