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Manifestations of Lyme Disease by Stage

System	Stage 1 (Localized Infection)	Stage 2 (Disseminated Infection)	Stage 3 (Persistent Infection)
Skin	▸ Erythema migrans	▸ Secondary annular lesions ▸ Malar rash ▸ Diffuse erythema or urticaria ▸ Evanescent lesions ▸ Lymphocytoma	▸ Acrodermatitis chronica atrophicans ▸ Localized scleroderma-like lesions
Musculoskeletal		▸ Migratory arthralgia ▸ Brief arthritis attacks ▸ Myositis ▸ Osteomyelitis ▸ Panniculitis	▸ Prolonged arthritis attacks ▸ Chronic arthritis ▸ Peripheral enthesopathy ▸ Periostitis or joint subluxations below acrodermatitis
Neurologic		▸ Meningitis ▸ Cranial neuritis or Bell's palsy ▸ Motor or sensory radiculoneuritis ▸ Encephalitis ▸ Mononeuritis multiplex ▸ Pseudotumor cerebri ▸ Myelitis ▸ Chorea ▸ Cerebellar ataxia	▸ Chronic encephalomyelitis ▸ Spastic parapareses ▸ Ataxic gait ▸ Mental disorders ▸ Chronic axonal polyradiculopathy ▸ Dementia
Lymphatic	▸ Regional lymphadenopathy	▸ Regional or generalized lymphadenopathy ▸ Splenomegaly
Heart		▸ Atrioventricular block ▸ Myopericarditis ▸ Pancarditis
Eyes		▸ Conjunctivitis ▸ Iritis ▸ Choroiditis ▸ Retinal hemorrhage or retinal detachment ▸ Panophthalmitis	▸ Keratitis
Liver		▸ Mild or recurrent hepatitis
Respiratory		▸ Nonexudative sore throat ▸ Nonproductive cough ▸ Adult respiratory distress syndrome
Kidney		▸ Microscopic hematuria or proteinuria
Genitourinary		▸ Orchitis
Constitutional systems	▸ Minor	▸ Severe malaise and fatigue	▸ Fatigue