Transverse myelitis secondary to coexistent Lyme disease and babesiosis

To describe transverse myelitis secondary to coexistent Lyme disease and babesiosis.

Case report.

A 74-year-old man presented with rapid onset of weakness, numbness, and tingling in his legs, with symptoms ascending to his hands and forearms within days. He recalled an insect bite to his scapular area 2 weeks earlier.

T2-weighted magnetic resonance imaging demonstrated diffuse hyperintensity from T1 through T12. Western blot and enzyme-linked immunosorbent assay identified infection with Borrelia burgdorferi, the spirochete responsible for Lyme disease. Giemsa-stained blood smears identified ring forms later recognized by polymerase chain reaction as Babesia microti, the piroplasm responsible for babesiosis. Initial examination revealed C7 motor and T3 sensory complete tetraplegia, with recovery to T4 paraplegia by 2 months.

The history, physical examination, imaging, and serologic studies were consistent with transverse myelitis related to Lyme disease and babesiosis. The severity and permanence of this patient's deficits were greater than those reported in the majority of previous cases of transverse myelitis due to Lyme disease alone, suggesting a possible role for coinfection with babesiosis.