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Acute transverse myelitis in Lyme neuroborreliosis

S Bigi1, C Aebi, C Nauer

  • 1Neuropaediatrics, Department of Paediatrics, University Children's Hospital, Inselspital, Bern, Switzerland. Sandra.bigi@insel.ch

Infection
|May 28, 2010
PubMed
Abstract

Insights

Acute transverse myelitis (ATM) can present with minimal symptoms despite severe spinal cord inflammation in Lyme neuroborreliosis. Early diagnosis is crucial, as the Borrelia burgdorferi sensu lato CSF/blood index may be negative initially.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Acute transverse myelitis (ATM) is a rare neurological disorder affecting the spinal cord, with a significant percentage of cases occurring in pediatric populations.
  • Diagnosis of ATM relies on clinical presentation and evidence of spinal cord inflammation via cerebrospinal fluid (CSF) analysis or magnetic resonance imaging (MRI).
  • Neuroborreliosis, an infection caused by Borrelia burgdorferi sensu lato bacteria, can manifest as ATM, often with pronounced clinical symptoms.

Observation:

  • This case report details a patient with Lyme neuroborreliosis-associated ATM presenting with severe MRI and CSF findings.
  • Despite significant spinal cord inflammation evident on imaging and in CSF, the patient exhibited surprisingly mild clinical manifestations.
  • The immunoglobulin G (IgG) CSF/blood index for Borrelia burgdorferi sensu lato showed a late conversion, indicating a delayed diagnostic marker.

Findings:

  • Clinical symptoms of neuroborrelial ATM can be minimal, even with substantial spinal cord involvement confirmed by imaging.
  • The CSF/blood index for Lyme neuroborreliosis may be negative in the early stages of the disease.
  • A negative early CSF/blood index does not rule out Lyme neuroborreliosis.

Implications:

  • Healthcare providers should consider Lyme neuroborreliosis in the differential diagnosis of ATM, even with subtle clinical signs.
  • Prompt treatment for suspected Lyme neuroborreliosis is recommended, irrespective of early negative CSF/blood index results.
  • Serial testing of the CSF/blood index may be necessary to confirm Lyme neuroborreliosis in ambiguous cases.

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