• Lyme disease is recognized as a cause of illness involving multiple organ systems. The transmission of the Borrelia burgdorferi spirochete depends on a complicated vector life cycle, involving multiple mammalian and avian hosts. Although the illness is reported worldwide, variable clinical presentations on different continents raise questions about disease mechanisms. Multiple neurologic syndromes can occur alone or in combination, producing peripheral neuropathies, radiculopathies, myelopathies, encephalitides, meningitides, and pain syndromes. These may be noted with dermatological, rheumatological, and cardiological syndromes. Several pathophysiologic mechanisms are reviewed. Antibiotic therapy for different clinical presentations is discussed.