Transverse Myelitis from Lyme Disease: A Case Study

Welcome to another Inside Lyme case discussion. One of the best ways to understand Lyme disease is by reviewing real clinical cases. In this episode, I discuss a 25-year-old man who developed acute transverse myelitis associated with Lyme disease.

Lyme disease can affect the nervous system in several ways, including inflammation of the brain, nerves, and spinal cord. In rare cases, infection with Borrelia burgdorferi can lead to transverse myelitis, a condition that disrupts nerve signals traveling through the spinal cord.

This case was first reported by Dumic and colleagues in the journal IDCases in 2019.

A previously healthy 25-year-old man presented with an inability to urinate along with frequent falls caused by weakness and numbness in both legs.

According to the authors, the patient developed progressive gait instability and weakness in his lower extremities. His symptoms worsened as the weakness spread through both legs.

MRI imaging revealed inflammation of the spinal cord consistent with myelitis. A spinal tap showed pleocytosis, an increased number of white blood cells in the cerebrospinal fluid.

Transverse myelitis occurs when inflammation damages the spinal cord, interrupting communication between the brain and the rest of the body.

The patient’s symptoms included motor weakness, sensory changes, and autonomic dysfunction—findings typical of acute transverse myelitis.

Based on the clinical presentation, MRI findings, and cerebrospinal fluid results, the physicians diagnosed the patient with acute transverse myelitis caused by Lyme disease.

Understanding Lyme Disease and Transverse Myelitis

Transverse myelitis is a neurologic condition caused by inflammation of the spinal cord. The inflammation can disrupt nerve signals between the brain and the body, leading to symptoms such as:

Weakness of the legs or arms
Sensory loss or numbness
Difficulty walking
Bladder dysfunction
Autonomic nervous system abnormalities

Although uncommon, Lyme disease has been associated with several spinal cord syndromes including transverse myelitis, radiculomyelitis, and inflammatory myelopathy.

Learn more about neurologic complications of Lyme disease in my overview of neurologic Lyme disease.

Lyme disease symptoms can affect many organ systems, including the nervous system. See my guide to Lyme disease symptoms.

Clinical Takeaway

This case highlights an important neurologic complication of Lyme disease. Patients presenting with unexplained weakness, gait problems, or bladder dysfunction should be evaluated for neurologic causes, including tick-borne infections.

Recognizing Lyme disease as a possible cause of acute transverse myelitis may allow clinicians to initiate appropriate testing and treatment earlier.

Inside Lyme Podcast Series

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Disclaimer: The information provided in this podcast is for educational purposes only and is not intended as medical advice for any individual patient. If you require specific medical advice, please consult an experienced healthcare professional.

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