Several syndromes derived from the involvement of central and peripheral nervous system and meninges have been reported in the infection by Borrelia burgdorferi. The features of autonomic nervous system involvement have received a marginal attention. Reflex sympathetic dystrophy is an autonomic picture characterized by regional sympathetic hyperactivity which has not been associated with Lyme disease. We report a 16-year-old female with clinical, radiological and scintigraphic features consistent with reflex sympathetic dystrophy. The usual causes of this syndrome were ruled out and antibodies against Borrelia burgdorferi were detected by immunofluorescence, enzyme immunoassay and Western blotting. Specific IgG and IgM levels had a progressive increase during three months. In Lyme borreliosis causes of false positives were excluded. Antigen-antibody bands were detected in increasing number during the evolution, using sonicates of B. burgdorferi and patient's sera with the Western blotting technique. Our data suggest that reflex sympathetic dystrophy is another type of nervous system involvement in the multifaceted Lyme borreliosis.