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This systematic review aims to summarize reported cases of Lyme borreliosis and relapsing fever (RF)\n                      <jats:italic>Borrelia<\/jats:italic>\n                      infections in patients receiving B\u2010cell\u2010depleting therapies, focusing on clinical manifestations, diagnostic challenges, and treatment outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic literature search was conducted using PubMed and the Web of Science Core Collection employing search terms linking B\u2010cell\u2010depleting therapies to Lyme borreliosis and to RF\n                      <jats:italic>Borrelia<\/jats:italic>\n                      infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The most reported cases in the literature were neurological infections due to\n                      <jats:italic>Borrelia;<\/jats:italic>\n                      there were 11 cases of Lyme neuroborreliosis and 8 cases of neurological infections due to\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>B. miyamotoi<\/jats:italic>\n                      <\/jats:styled-content>\n                      reported. Lyme neuroborreliosis cases all exhibited negative serology. Pleocytosis of cerebrospinal fluid (CSF) was, however, always present, and PCR could confirm the diagnosis in 8 cases. Diagnosis in all\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>B. miyamotoi<\/jats:italic>\n                      <\/jats:styled-content>\n                      cases relied exclusively on direct detection methods. All patients responded to standard antibiotic regimens, although persistent symptoms were reported in some cases. The other infections were 7 erythema migrans (EM), 4 disseminated Lyme borreliosis, and 3 cases of relapsing fever.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Neurological Borrelia infections may be underrecognized in patients on B cell\u2010depleting therapies due to atypical presentations and negative serologies. Early consideration of direct diagnostic methods such as PCR or indirect methods such as CSF CXCL13 levels is critical. Neurologists should maintain a high index of suspicion for\n                      <jats:italic>Borrelia<\/jats:italic>\n                      infections in immunocompromised patients presenting with CSF pleocytosis and neurological symptoms.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70483","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T06:41:01Z","timestamp":1768977661000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["<i>Borrelia<\/i>\n                    Infections Under B Cell\u2010Depleting Therapies: A Systematic Review of Diagnostic Challenges and Outcomes With Special Focus on Neurological Forms"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1491-0779","authenticated-orcid":false,"given":"Emilie","family":"Cardot\u2010Martin","sequence":"first","affiliation":[{"name":"Institut de 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