Early Neuroborreliosis
During this stage the Borrelia spreads into other tissues which can include the skin, nervous system, heart and musculoskeletal system. This can result in a wide variety of signs and symptoms which may present from a few weeks to over a year after the initial infection.

More severe symptoms can include multiple EM (often smaller than an initial lesion), joint and muscle pain and inflammation, radiculopathy (usually occurring months rather than weeks after infection) and carditis with conduction defects (usually partial heart block).

None of the presentations are unique to Borreliosis but combined with a history of tick exposure, or confirmed tick bite, are suggestive of the condition.