Background: Lyme disease (Lyme disease-LD) is a disease of humans and animals that is transmitted by hematophagous insects, especially ticks. The causative agent is the spirochete Borrelia burgdorferi, a bacterium with a complex structure and a slow biorhythm, which has the ability to coat the host's organism with mucus - create a biofilm - or turn into a cyst, and the host does not recognize it and does not create antibodies. This is the reason why, in 10-60% of cases, Borrelia tests are negative, even though it is present. The diagnosis of LD is made clinically, and it is confirmed serologically and microbiologically by isolation and/or detection of the causative agent by the PCR method from tissue samples and body fluids. Lyme disease stage II and III is called „the great imitator“ because its symptoms resemble those of other diseases, so diagnostic errors are often made. Objective: In this article we presented a case of stubborn urticaria in a 28-year-old saleswoman. Case presentation: Mother of two children, who was ruled out by clinical examination for autoimmune diseases and allergies to available allergens. We subsequently confirmed the diagnosis of chronic borreliosis, caused by five types of borrelia, serologically, after advanced intermittent antibiotic therapy, and after acquired food intolerance was discovered. In the available literature, we did not find information that chronic generalized urticaria was caused by Borrelia in combination with food intolerance. Conclusion: The presented case of a patient with chronic urticaria indicates that similar cases with urticaria, as well as all skin changes with intermittent walking symptomatology, should: Undergo clinical treatment, rule out immunological diseases and drug allergies, then test for Borrelia (ELISA+ immunoblot with Borrelia protein sequences!). Take into account the duration of the disease, the possibility of the disappearance of antibodies created in early childhood or a false-negative finding of antibodies, and in case of a negative finding, do not give up ex-yuvantibus therapy.
Key words: chronic urticaria, chronic borreliosis, food intolerance.
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