Lyme Meningitis and Radiculitis: A Neuroborreliosis Case
Lyme meningitis can occur when Lyme disease spreads to the nervous system. In some patients, meningitis is accompanied by radiculitis — inflammation of nerve roots that can cause severe lancinating pain, weakness, tremor, and emotional symptoms.
In this case, a 43-year-old man initially presented with fever, headache, neck stiffness, and photophobia. Because he refused a lumbar puncture, doctors presumed viral meningitis. One month later he returned with dramatic neurologic deterioration including progressive weakness, intractable radicular pain, tremor affecting both his hands and legs, along with depression and anxiety. A spinal tap eventually revealed lymphocytic pleocytosis consistent with neuroborreliosis requiring intravenous ceftriaxone.
Lyme meningitis is one manifestation of neurologic Lyme disease, also known as Lyme neuroborreliosis.
Inside Lyme Podcast: Meningitis and Radiculitis Case
Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this episode, I discuss a case involving a 43-year-old man who developed meningitis and radiculitis as neurologic complications of Lyme disease.
The Initial Presentation
The case was published in the journal Neurology International.
According to Dabiri and colleagues
, the patient previously had a scaly erythematous macular rash on his proximal medial upper and lower extremities.
Within two weeks he developed cough, fever, anorexia, malaise, fatigue, myalgias, neck stiffness, mild photophobia, and headache.
This combination of symptoms — fever, headache, neck stiffness, and photophobia — represents the classic meningitis triad. Combined with the prior rash, the presentation strongly suggests early disseminated Lyme disease with neurologic involvement.
The Diagnostic Delay: Refusing Lumbar Puncture
Initial laboratory testing revealed mild abnormalities in liver function but no evidence of Lyme disease. At the onset of symptoms the patient refused to undergo a lumbar puncture.
Without cerebrospinal fluid analysis, physicians presumed viral meningitis. Lyme meningitis and viral meningitis can appear clinically similar, making lumbar puncture critical for establishing the diagnosis.
Neurologic Deterioration One Month Later
One month later the patient developed progressive weakness, severe radicular pain, emotional lability, depression, anxiety, and tremor affecting both his hands and legs.
The progression from meningitis to severe radiculoneuropathy illustrates the natural history of untreated neuroborreliosis.
- Progressive weakness: muscle denervation from radiculitis
- Severe lancinating pain: sharp nerve-root pain
- Hand tremor: interfering with fine motor tasks
- Leg tremor: causing imbalance and instability
- Emotional lability: rapid mood changes
- Depression and anxiety: psychiatric manifestations of CNS involvement
Central and Peripheral Nervous System Involvement in Lyme Neuroborreliosis
Manifestations of the central nervous system such as meningitis and peripheral nervous system involvement such as radiculitis may occur independently or together.
Radiculitis results from inflammation of spinal nerve roots and can lead to severe pain, weakness, and sensory abnormalities along affected dermatomes.
The Spinal Tap That Confirmed the Diagnosis
Lumbar puncture revealed lymphocytic pleocytosis with a white blood cell count of 225, elevated protein of 77 mg/dL, and decreased glucose of 38 mg/dL.
- WBC 225: significant central nervous system inflammation
- Lymphocytic predominance: typical of spirochetal infection
- Elevated protein: blood-brain barrier disruption
- Low glucose: supports bacterial or spirochetal meningitis
This pattern is characteristic of Lyme meningitis and helps distinguish it from viral meningitis.
Treatment and Clinical Improvement
The patient received a five-day course of doxycycline followed by one month of intravenous ceftriaxone.
Within two weeks he reported significant improvement including resolution of pain, weakness, and psychiatric symptoms, although some ambulatory difficulty persisted.
Clinical Perspective
This case highlights the consequences of delayed diagnosis in Lyme meningitis. Early symptoms strongly suggested meningitis following a rash consistent with erythema migrans. Because lumbar puncture was refused, viral meningitis was presumed and treatment was delayed.
During that month the infection progressed to severe meningoradiculoneuropathy affecting both the central and peripheral nervous systems.
Psychiatric symptoms such as emotional lability, depression, and anxiety may represent direct central nervous system involvement in neuroborreliosis. The rapid improvement following antibiotic therapy supports an infection-driven cause.
Podcast Discussion Questions
- What is Lyme meningitis?
- What is Lyme radiculitis?
- Why is this case unusual?
- Can central and peripheral nervous system involvement occur together?
- What is the significance of the rash?
- Why was viral meningitis presumed?
- How important is lumbar puncture in diagnosis?
- What treatment options are available?
- Could earlier treatment have prevented complications?
Related Neurologic Lyme Disease Cases
- Neurologic Lyme Disease Overview
- Brain Fog in Lyme Disease
- Psychiatric Symptoms in Lyme Disease
- Brachial Plexopathy in Lyme Disease
Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com.
Please remember that the advice given is general and not intended as specific advice for any individual patient.
