Acute Transverse Myelitis in a 25-Year-Old Man With Lyme Disease
Acute transverse myelitis is a rare but serious neurologic complication of Lyme disease that can lead to significant disability if not recognized early.
Acute transverse myelitis (ATM) is characterized by bilateral motor, sensory, and autonomic dysfunction. Symptoms may progress rapidly over hours to days, writes Dumic. [5]
Approximately one-third of patients are left with severe neurologic disability, highlighting the importance of early diagnosis and treatment.
Causes of Acute Transverse Myelitis
ATM may be associated with:
- Autoimmune disorders
- Bacterial or viral infections
- Multifocal central nervous system disease
However, in approximately 64% of cases, the cause remains unknown.
Case Presentation
Dumic describes a previously healthy 25-year-old man who presented with secondary erythema migrans, aseptic meningitis, and clinical features of transverse myelitis.
Initial symptoms included:
- Headache lasting two weeks
- A circular rash (~10 cm) on the thigh
Neurologic symptoms followed:
- Weakness and numbness in both lower extremities
- Urinary retention and constipation
- Fever, chills, and neck stiffness
Diagnostic Challenges
Serologic blood tests for Lyme disease were negative. However, cerebrospinal fluid testing was positive for Lyme disease by PCR.
This case highlights the limitations of standard testing and the importance of considering Lyme disease in patients with neurologic symptoms.
Learn more about Lyme disease testing challenges and why diagnosis may be missed.
Treatment and Outcome
The patient was treated with intravenous ceftriaxone for 28 days along with methylprednisolone.
He experienced near-complete recovery, although persistent bladder dysfunction required intermittent self-catheterization.
“While acute transverse myelitis is an infrequently encountered complication of Lyme disease, it can have devastating consequences if not recognized and treated early.”
How Common Is This?
Acute transverse myelitis associated with Lyme disease is rare.
The authors identified only six reported cases of Lyme neuroborreliosis-related ATM, with most occurring in Europe and only one in the United States.
Clinical Perspective
This case underscores the importance of recognizing rare neurologic manifestations of Lyme disease.
In endemic areas, clinicians should consider Lyme disease in patients presenting with acute neurologic syndromes—even when initial blood tests are negative.
Early diagnosis and treatment can significantly improve outcomes.
Related Articles:
Lyme disease manifesting as acute transverse myelitis
Six cases of neuroinvasive Lyme disease
Seizures and altered mental status after a tick bite
References:
- Hemmer B, Glocker FX, Kaiser R, Lucking CH, Deuschl G. Unusual neurologic manifestation of Borrelia infection. J Neurol Neurosurg Psychiatry. 1997.
- Logigian EL, Kaplan RF, Steere AC. Chronic neurologic Lyme disease. N Engl J Med. 1990.
- Kanjwal K, Karabin B, Kanjwal Y, Grubb BP. POTS following Lyme disease. Cardiol J. 2011.
- Agarwal AK, Garg R, Ritch A, Sarkar P. POTS overview. Postgrad Med J. 2007.
- Dumic I, Vitorovic D, Spritzer S, et al. Acute transverse myelitis in Lyme neuroborreliosis. IDCases. 2019.
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
I am always suspicious of the word rare used in connection with lyme. Rarely published on or rarely diagnosed is usually a better description. If this man still needs catheters, then he is probably still not cured of lyme. Strange how the author ignored that possibility.
Totally agree with you!
Agree Lou. I too was thought to have transverse myelitis on my spine, after being admitted in the hospital for 2 weeks with numbness to my front and back trunk. That was in addition to the lesions on my brain and heart that looked like MS or another disease.
I was diagnosed with Idiopathic Transverse Myelitis caused by Lyme and live in the US!!! My TM recently relapsed and MRI showed the return as did my Borrelia IgG and IgM! Pretty sure the numbers are higher!
I was diagnosed with Idiopathic Transverse Myelitis caused by Lyme and live in the US!!! My TM recently relapsed and MRI showed the return as did my Borrelia IgG and IgM! Pretty sure the numbers are higher!