Lyme disease is a tick-transmitted infection with disabling sequelae and important occupational health implications for a military workforce. It is likely that some military patients with typical clinical signs remain undiagnosed and untreated. Prompt treatment with an antibiotic is essential, besides targeted education on preventing infection through avoiding exposure to tick bites. We describe four British Forces Germany personnel (two serving military personnel, one adult civilian, one child) who during 2002--2003 required hospital inpatient treatment for Lyme disease. The epidemiology, pathogenesis, clinical features, diagnosis and treatment of the disease are discussed.