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We used immunoblotting to improve the specificity of the serologic diagnosis of
Lyme borreliosis in cases of acute facial palsy. Twelve of 15 patients (80%) with suspected
Lyme borreliosis, versus 0 of 10 controls, were positive by immunoglobulin M immunoblotting of acute-phase sera and 3 were negative, including 2 with borderline enzyme immunoassay results. Immunoglobulin M immunoblotting is a useful test to confirm Borrelia burgdorferi infection in patients with acute facial palsy and a positive enzyme immunoassay result.