Kobayashi, Takaaki, Higgins, Yvonne, Melia, Michael T et al. · The American journal of medicine · 2022 · DOI
This study looked at over 1,000 patients who were referred to a hospital thinking they had Lyme disease, but actually didn't. The doctors found that 84% of these patients did not have Lyme disease at all. Instead, they had many other conditions causing their symptoms, including anxiety, depression, fibromyalgia, and chronic fatigue syndrome. This suggests that Lyme disease is being diagnosed too often when patients actually have other medical problems.
For ME/CFS patients and researchers, this study is important because it demonstrates that ME/CFS (along with fibromyalgia and other post-infectious conditions) is frequently misidentified as Lyme disease in clinical practice. Understanding this diagnostic confusion helps explain why some ME/CFS patients may have received incorrect Lyme disease diagnoses and treatment, and highlights the need for improved diagnostic criteria and clinical awareness to distinguish between these overlapping symptom presentations.
This study does not prove that Lyme disease and ME/CFS are mutually exclusive or that patients cannot have both conditions simultaneously. It also does not establish causation or mechanisms for why symptoms develop in these alternative diagnoses, only that they are more commonly present than Lyme disease in this referred population. The retrospective design limits causal inference and generalizability beyond the specific referral population studied.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Kobayashi, Takaaki, Higgins, Yvonne, Melia, Michael T, & Auwaerter, Paul G (2022). Mistaken Identity: Many Diagnoses are Frequently Misattributed to Lyme Disease.. The American journal of medicine. https://doi.org/10.1016/j.amjmed.2021.10.040
BibTeX
@article{mecfsatlas-kobayashi-2022-mistaken-identity,
author = {Kobayashi, Takaaki and Higgins, Yvonne and Melia, Michael T and Auwaerter, Paul G},
title = {Mistaken Identity: Many Diagnoses are Frequently Misattributed to Lyme Disease.},
journal = {The American journal of medicine},
year = {2022},
doi = {10.1016/j.amjmed.2021.10.040},
note = {PubMed: 34861197},
url = {https://www.mecfsatlas.com/evidence/kobayashi-2022-mistaken-identity},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/kobayashi-2022-mistaken-identity
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