Lyme disease is rare in the U.K. but there is evidence of an increase in both prevalence of, and patient concern about, the infection. There are no published data characterising Lyme disease as it is seen in the U.K. The clinical and laboratory features of 65 patients diagnosed with the disease between 2002 and 2007 were recorded and their clinical presentation and response to treatment documented. In total, 34% of patients acquired the infection in the UK, 20% in North America and 46% in Europe. Exposure to ticks was reported by 58% of patients. Erythema migrans was seen in 91%, systemic upset in 62%, headaches in 31%, arthralgia or arthritis in 28%, radiculitis in 11% and cranial nerve palsies in 4.6%. Screening enzyme immunoassay tests were negative in 39% and reference laboratory immunoblots were negative in 31% of patients, principally those with early infection. The majority of patients were cured with one course of antibiotic treatment, three patients had evidence of persistent infection after treatment and two required intravenous therapy. No cases of chronic Lyme disease were seen.