- Other patients may present with fractures, bone pain, cranial nerve palsies and osteomyelitis.
- As the infection spreads in the temporal bone, it may extend into the cranium and result in cranial nerve palsies.
- The most common manifestation in children is erythema migrans rash followed by arthritis, facial nerve palsy, aseptic meningitis, and carditis.
- The paralysis or palsy may affect mainly the legs, or all four limbs, or just one side of the body.
- The presentation may be of an unexplained mass or cranial nerve palsies, meningeal symptoms, or even respiratory problems caused by brainstem infiltration.