ObjectivesLyme serology does not readily discriminate an active Lyme borreliosis (LB) from a previousBorreliainfection or exposure. Here, we aimed to investigate a large number of immunological protein biomarkers to search for an immunological pattern typical for active LB, in contrast to patterns found in healthy blood donors, a proportion of whom were previously exposed toBorrelia.MethodsSerum samples from well-characterised adult patients with ongoing LB and healthy blood donors were included and investigated using a proximity extension assay (provided by Olink®) by which 92 different immune response-related human protein biomarkers were analysed simultaneously.ResultsIn total, 52 LB patients and 75 healthy blood donors were included. The blood donors represented both previouslyBorreliaexposed (n = 34) and not exposed (n = 41) based on anti-Borreliaantibody status. Ten of the examined 92 proteins differed between patients and blood donors and were chosen for further logistic regression (p<0.1). Six proteins were statistically significantly different between LB patients and blood donors (p<0.05). These six proteins were then combined in an index and analysed using receiver-operating-characteristic curve analysis showing an area under the curve of 0.964 (p<0.001).ConclusionsThe results from this study suggest that there is an immunological protein pattern that can distinguish a presentBorreliainfection from a previous exposure as well as anti-Borreliaantibody negative blood donors. Although this method is not adapted for routine clinical use at this point, the possibility is interesting and may open new diagnostic opportunities improving the laboratory diagnostics of LB.