A Rare Presentation of Lyme Neuroborreliosis: Multifocal Cervical and Thoracic Transverse Myelitis-A Case Report.

Abstract

Background: Spinal cord involvement in Lyme disease is an uncommon manifestation of neuroborreliosis, with myelitis representing a rare clinical entity. Multifocal transverse, non-contiguous spinal cord involvement remains particularly rare and is insufficiently characterized in the existing literature.

Case report: We report the case of a 40-year-old previously healthy woman who presented with rapidly progressive paraparesis, ascending sensory deficits, and bladder and bowel dysfunction consistent with acute-subacute inflammatory myelopathy. Spinal magnetic resonance imaging (MRI) demonstrated multifocal non-contiguous inflammatory lesions involving the cervical and thoracic spinal cord. Extensive microbiological and serological investigations excluded alternative infectious aetiologies. Brain MRI showed no evidence of demyelinating disease. Despite clinically significant spinal cord inflammation, cerebrospinal fluid (CSF) analysis revealed neither pleocytosis nor elevated protein concentration. However, Borrelia-specific IgM antibodies were detected in both serum and CSF, and a positive Borrelia-specific antibody index (AI 3.07) confirmed intrathecal anti-Borrelia antibody synthesis, establishing the diagnosis of Lyme neuroborreliosis-associated myelitis. The patient subsequently demonstrated marked neurological improvement following targeted treatment with intravenous ceftriaxone combined with corticosteroids and supportive therapy.

Conclusion: This case significantly expands the recognized spectrum of spinal cord involvement in Lyme disease-associated neuroborreliosis by delineating an extremely rare multifocal presentation, thereby emphasizing the critical importance of recognizing atypical manifestations in the diagnostic evaluation of inflammatory myelopathies.

Learning points: Multifocal non-contiguous transverse myelitis is an unusual manifestation of Lyme neuroborreliosis.Lyme-associated inflammatory myelitis may occur even in the absence of classical cerebrospinal fluid abnormalities or documented tick exposure.Early recognition and antimicrobial treatment improve neurological recovery.