Lyme Disease Beyond Erythema Migrans: Bilateral Uveitis and Hip Arthritis in a Young Woman

Background: Lyme disease is a tick-borne infection caused by Borrelia burgdorferi sensu lato and represents one of the most common vector-borne diseases in Europe. Although erythema migrans is considered its hallmark manifestation, atypical presentations lacking characteristic cutaneous findings may pose significant diagnostic challenges, particularly in regions of low disease prevalence. Case Presentation: A 33-year-old woman with no significant past medical history was admitted with a five-day history of high-grade fever, left cervical lymphadenopathy, and a diffuse maculopapular rash involving the trunk and upper limbs. Physical examination revealed an eschar on the medial aspect of the right ankle. During hospitalization, she developed bilateral red eye and was diagnosed with bilateral anterior uveitis. Subsequently, she reported left hip pain, and imaging studies demonstrated findings consistent with inflammatory arthritis of the left hip joint. An extensive diagnostic workup excluded autoimmune, viral, and other arthropod-borne infectious diseases. Initial serological testing for Borrelia burgdorferi was inconclusive; however, confirmatory testing later demonstrated positive IgM and IgG antibodies. The patient received empirical antimicrobial therapy with doxycycline and ceftriaxone, resulting in progressive clinical improvement and resolution of symptoms. Conclusion: This case highlights the diagnostic complexity of atypical Lyme disease presenting without erythema migrans and with uncommon manifestations, including bilateral anterior uveitis and hip arthritis. Clinicians should maintain a high index of suspicion for Lyme disease in patients presenting with fever, rash, ocular inflammation, and musculoskeletal involvement, particularly when epidemiological exposure to ticks is suspected. Early recognition and prompt treatment are essential to prevent disease progression and long-term complications.