The patient had acute Lyme disease in which a liver abscess was detected on examination of abnormal liver function tests. Eight months earlier, he had undergone a liver ultrasound for suspected abdominal aneurysm, and no abscess was present. No other cause of liver abscess was found. The abscess arose as a complication of acute Lyme disease. After treatment, the abscess healed simultaneously with antibiotic therapy for Lyme disease. This is a case report that describes this rare case.