Lyme Disease and Transverse Myelitis: Case Report of Spinal Cord Inflammation
SPINAL CORD INFLAMMATION?
COULD IT BE LYME DISEASE?
Can Lyme disease cause inflammation of the spinal cord?
Quick Answer: Lyme disease can cause transverse myelitis, a rare but serious form of spinal cord inflammation that may present differently from typical cases.
Clinical Insight: When neurologic symptoms are atypical or do not respond as expected to standard therapies, clinicians should consider infectious causes—including Lyme disease—especially in endemic areas.
In their article “Case report: Subacute transverse myelitis with gait preservation secondary to Lyme disease and a review of the literature,” Colot and colleagues describe a 10-year-old boy with neck pain radiating to the upper limbs for 13 days.
Transverse myelitis (TM) is an inflammation affecting both sides of one section of the spinal cord. Diagnosis requires clinical symptoms along with evidence of inflammation on MRI or cerebrospinal fluid analysis.
Treatment of transverse myelitis typically includes steroids, intravenous immunoglobulins, plasma exchange, and immunomodulatory therapies.
“Clinical features consist of sensory disturbances in most patients, followed by weakness and sphincter dysfunction. Children suffer from more severe clinical impairment than adults,” the authors wrote.
One study found that 89% of pediatric patients were bed- or wheelchair-bound or required assisted ventilation.
In this case report, the clinical presentation differed from classic transverse myelitis.
“TM secondary to Lyme disease is more often subacute with gait preservation and is limited to the cervical spine,” the authors wrote.
Lyme Disease Triggers Inflammation in the Spinal Cord
A 10-year-old boy presented with persistent nocturnal and rotational neck pain radiating to the upper limbs, along with paresthesia and a feeling of heaviness.
The boy also had a fever for 11 days, along with fatigue and headaches.
MRI findings of the spine suggested longitudinal extensive transverse myelitis (LETM).
“A spinal MRI showed an extensive T2 hypersignal between C1 and C7…”
An extensive workup was performed. CSF analysis revealed an increased white blood cell count.
The patient was treated with high-dose methylprednisolone IV and ceftriaxone.
After initial improvement, antibiotics were stopped—but symptoms returned shortly thereafter.
“Steroids do not seem to improve the prognosis.”
Given the patient lived in a tick-endemic area, Lyme disease was considered.
Testing confirmed Borrelia infection through IgG antibodies and intrathecal synthesis.
The patient reported a prior erythematous lesion suggestive of erythema migrans but did not recall a tick bite.
After 23 days of ceftriaxone and doxycycline, the patient made a complete recovery.
This pattern reflects broader presentations seen in neurologic Lyme disease, where symptoms may not follow typical expectations.
Key Differences in Lyme-Associated Transverse Myelitis
The authors emphasize five distinguishing features:
- Subacute presentation
- Cervical spine involvement
- Preserved gait
- Minimal sphincter dysfunction
- Recovery after prolonged antibiotic therapy
These findings highlight how Lyme-associated transverse myelitis differs from classical TM.
When symptoms do not match typical patterns, diagnosis may be delayed—similar to challenges described in delayed Lyme diagnosis.
Clinical Perspective
This case underscores the importance of considering Lyme disease in patients with atypical neurologic symptoms.
Early empiric treatment may be critical, particularly when symptoms evolve or do not respond to standard therapy.
Atypical presentations should prompt reconsideration—not diagnostic closure.
Authors Conclude:
“After an extensive review of the pediatric literature, we wish to emphasize five aspects of TM secondary to Lyme disease:”
- presentation is more often subacute
- lesions are mainly located in the cervical spine
- gait is usually preserved
- sphincter dysfunction is unusual
- recovery is usually complete after prolonged antibiotic therapy
The authors suggest that subacute presentation, gait preservation, and discordance between imaging findings and clinical symptoms should raise suspicion for Lyme-associated transverse myelitis.
Related Articles:
Podcast: Transverse Myelitis and Lyme disease
Subacute Transverse Myelitis Caused by Borrelia Infection
Could Lyme disease have led to a spinal cord lesion?
References:
- Colot C, et al. Case report: Subacute transverse myelitis with gait preservation secondary to Lyme disease. Front Pediatr. 2023.
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
These authors need to have a few more adults.
I have personally had all this, lacking the mri or spinal tap to prove it.
Sphincter disfunction misdiagnosed as Gerd and a second time as food poisoning when no one else that ate the same food got sick. Previous tests did prove the disfunction, but facilities not having the same access to medical information.
Mine was not limited to cervical disfunction as it was not treated. I also had disfunction in the legs caused by lower spinal pain. There is also a third area in the spine that causes pain and disfunction.
The issue with adults here is that most are overlooked due to age and age related pain that is not taken seriously. Some, for women is passed off as perimenopausal, menopausal, or post menopausal.
For men, it is attributed to their jobs or history of yard work. For me it was both because I had been performing similar types of work around my home and age of onset was 47, considered to be perimenopausal.
I agree. Adults, (myself) not taken seriously. “You are just getting old and are out of shape.” I was in my 40’s and first one shoulder locked up and then the other until I couldn’t dress myself. Tinglings in the hands and sudden hot, red face with tingling as if I had applied Tiger Balm on my face. Those symptoms went away after a few weeks followed by lower back pain and chronic neck pain for years until begging Dr’s to test for Lyme. I live in North Idaho. Supposedly Lyme doesn’t exist there. It all sounds familiar as this young boy.
I have Thoracic spine pain from Lyme ….