Lyme Disease Manifesting as Acute Transverse Myelitis

Lyme disease may rarely involve inflammation of the spinal cord
Back pain, muscle spasms, and sensory symptoms may reflect neurologic Lyme disease
Early recognition and treatment may improve neurologic recovery

Acute transverse myelitis is an inflammatory disorder involving the spinal cord that may arise from autoimmune, infectious, inflammatory, or demyelinating conditions. In rare cases, Lyme neuroborreliosis may present as acute transverse myelitis with back pain, muscle spasms, sensory changes, weakness, gait difficulty, and autonomic dysfunction.

Lyme disease may occasionally present with spinal cord inflammation rather than simple musculoskeletal pain. Patients with Lyme-associated transverse myelitis may initially report thoracic pain, flank pain, radicular pain, muscle tightness, or a band-like sensation around the trunk before developing more obvious neurologic deficits.

Acute transverse myelitis can develop suddenly over hours to days and may lead to weakness, numbness, bowel or bladder dysfunction, gait instability, and sensory loss below the level of spinal cord involvement. MRI imaging may reveal inflammatory lesions involving the thoracic or cervical spinal cord.

Although viral and autoimmune causes are more commonly recognized, Lyme neuroborreliosis remains an important infectious consideration in endemic regions. Clinicians evaluating unexplained transverse myelitis should consider Lyme disease in patients with possible tick exposure, rash history, migratory symptoms, neuropathic complaints, or fluctuating neurologic findings.

Neurologic Lyme disease can involve both the central and peripheral nervous systems. Reported manifestations include meningitis, cranial neuropathies, radiculopathy, peripheral neuropathy, autonomic dysfunction, encephalopathy, and—in rare cases—myelitis involving the spinal cord.

Back pain in Lyme disease is often multifactorial. Some patients experience musculoskeletal pain from inflammation, while others develop neuropathic pain related to nerve root irritation or spinal cord involvement. Muscle spasms, stiffness, weakness, sensory changes, and gait abnormalities may suggest neurologic involvement rather than uncomplicated mechanical back pain.

Diagnostic evaluation may include MRI imaging, cerebrospinal fluid analysis, Lyme serologic testing, and exclusion of alternative inflammatory, autoimmune, infectious, or demyelinating disorders.

Recent reviews on acute transverse myelitis emphasize the importance of identifying the underlying cause early because prognosis and treatment vary substantially depending on the mechanism of spinal cord injury. Infectious-associated transverse myelitis may improve with prompt treatment directed at the underlying infection.

Treatment for Lyme-associated transverse myelitis generally includes antibiotics directed at Lyme neuroborreliosis. Some patients may also receive corticosteroids, rehabilitation, or supportive neurologic care depending on the severity of inflammation and clinical presentation.

Delayed diagnosis may increase the risk of persistent neurologic symptoms, chronic pain, gait impairment, autonomic dysfunction, or prolonged recovery.

Frequently Asked Questions

Can Lyme disease cause transverse myelitis?

Yes. Although uncommon, Lyme disease has been reported as a cause of acute transverse myelitis involving inflammation of the spinal cord.

Can Lyme disease cause back pain?

Yes. Lyme disease back pain may result from musculoskeletal inflammation, radiculopathy, neuropathic pain, or—in rare neurologic cases—spinal cord involvement.

Can infections trigger acute transverse myelitis?

Yes. Acute transverse myelitis has been associated with viral, bacterial, autoimmune, inflammatory, and demyelinating disorders. Lyme neuroborreliosis is considered a rare infectious cause.

What are symptoms of Lyme-associated transverse myelitis?

Symptoms may include thoracic pain, flank pain, muscle spasms, numbness, weakness, gait difficulty, urinary symptoms, sensory loss, and a band-like sensation around the trunk.

Can Lyme disease cause spinal cord lesions?

In rare neurologic cases, MRI imaging may reveal inflammatory lesions involving the spinal cord in patients with Lyme neuroborreliosis.

Is Lyme-associated transverse myelitis treatable?

Many patients improve with antibiotic treatment and supportive neurologic care, especially when the condition is recognized early.

Clinical Takeaway

Lyme disease manifesting as acute transverse myelitis remains uncommon but clinically important. Modern reviews emphasize that transverse myelitis is a syndrome with many potential causes, including autoimmune, inflammatory, infectious, and demyelinating disorders. In endemic regions, Lyme neuroborreliosis should remain part of the differential diagnosis in patients presenting with unexplained spinal cord inflammation, back pain, muscle spasms, sensory changes, weakness, gait dysfunction, or autonomic symptoms. Early recognition may improve neurologic recovery and reduce long-term disability.

Related Articles

Neurologic Lyme Disease
Lyme Disease Symptoms Guide
Autonomic Dysfunction and Lyme Disease
Post-Treatment Lyme Disease Syndrome

References

1. Tisavipat N, Flanagan EP. Current perspectives on the diagnosis and management of acute transverse myelitis. Expert Rev Neurother. 2023;23(4):389-411.
2. Krishnan C, Kaplin AI, Pardo CA, Kerr DA, Keswani SC. Transverse myelitis: pathogenesis, diagnosis and treatment. Front Biosci. 2004;9:1483-1499.

---

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention