Acute Transverse Myelitis in Lyme Disease Patients
Acute transverse myelitis is a rare neurologic complication of Lyme disease.
Symptoms may progress rapidly and involve motor, sensory, and autonomic dysfunction.
Early recognition and treatment may improve recovery.
Acute transverse myelitis (ATM) is a rare neurologic condition that can leave approximately one-third of patients with severe neurologic disability. The disorder is characterized by varying degrees of bilateral motor, sensory, and autonomic dysfunction.
Symptoms can worsen rapidly over hours or may evolve more gradually over several days, explains Dumic from the Mayo Clinic and lead author of the case report “Acute transverse myelitis: A rare clinical manifestation of Lyme neuroborreliosis.”
As Dumic points out, acute transverse myelitis may occur in association with autoimmune disorders, bacterial infections, or viral infections. However, in many patients, the cause remains unclear.
“In about 64 percent of cases, ATM is classified as idiopathic,” writes Dumic. The remaining cases are generally associated with systemic inflammatory disease, infections, or multifocal central nervous system disease.
Acute Transverse Myelitis Has Been Reported in Lyme Disease
Although uncommon, acute transverse myelitis has been described in patients with Lyme neuroborreliosis.
Dumic describes the case of a previously healthy 25-year-old man who presented with secondary erythema migrans, aseptic meningitis, and clinical features of acute transverse myelitis.
The patient developed bilateral lower-extremity weakness and numbness along with urinary retention and constipation.
[bctt tweet=”Acute transverse myelitis, a serious neurological syndrome, has been seen in patients with Lyme disease.” username=”DrDanielCameron”]
Initially, the patient experienced headaches lasting approximately two weeks along with a red circular rash roughly 10 cm in diameter on his left thigh. The rash resolved before hospitalization.
He later developed neck stiffness, fevers, chills, urinary symptoms, constipation, and progressive weakness and numbness involving his lower extremities.
“While acute transverse myelitis is an infrequently encountered complication of Lyme disease, it can have devastating consequences if not recognized and treated early.”
Lyme Testing Can Be Challenging in Neurologic Cases
The patient lived in Wisconsin and frequently participated in outdoor activities including hiking, camping, and fishing. He reportedly did not recall a tick bite.
Interestingly, serologic blood testing for Lyme disease was negative. However, spinal fluid testing by PCR was positive for Lyme disease.
This case also illustrates how difficult neurologic Lyme disease can sometimes be to confirm early in the evaluation.
Learn more about neurologic Lyme disease and the challenges surrounding diagnosis.
Recovery May Occur, But Residual Symptoms Can Persist
The patient was treated with methylprednisolone and IV ceftriaxone for 28 days and experienced near-complete recovery.
However, he continued to experience lingering bladder dysfunction requiring intermittent self-catheterization.
While some patients improve significantly with treatment, neurologic Lyme disease can leave persistent symptoms involving autonomic function, weakness, sensory disturbances, or bladder dysfunction.
Acute Transverse Myelitis Remains Rare in Lyme Neuroborreliosis
Acute transverse myelitis associated with Lyme disease remains uncommon in the medical literature.
“Our search yielded 6 cases of LNB [Lyme neuroborreliosis]-related ATM… Interestingly, only one case was reported from the U.S. and the rest were from Europe,” writes Dumic.
The authors recommend that clinicians in Lyme-endemic regions remain aware of this rare neurologic presentation in order to diagnose and treat patients as early as possible.
Learn more about Lyme disease manifesting as acute transverse myelitis and other severe neurologic complications associated with Lyme neuroborreliosis.
Frequently Asked Questions
What is acute transverse myelitis?
Acute transverse myelitis is an inflammatory neurologic condition involving the spinal cord that can affect motor function, sensation, and autonomic nervous system activity.
Can Lyme disease cause transverse myelitis?
Although rare, Lyme neuroborreliosis has been reported in association with acute transverse myelitis in both U.S. and European case reports.
What symptoms can occur with acute transverse myelitis?
Symptoms may include weakness, numbness, bladder dysfunction, constipation, sensory loss, gait problems, and autonomic dysfunction.
Can Lyme blood tests be negative in neurologic Lyme disease?
Yes. Some neurologic Lyme disease cases may initially have negative blood tests while spinal fluid testing or later serologic testing provides additional evidence supporting the diagnosis.
Can patients recover from Lyme-associated transverse myelitis?
Some patients improve substantially with treatment, although persistent neurologic or autonomic symptoms may remain.
Related Articles:
Lyme disease manifesting as acute transverse myelitis
Six cases of neuroinvasive Lyme disease
Seizures and altered mental status after a tick bite
Neurologic Lyme disease presenting as abdominal pain in 71-year-old patient
At least 50% of patients with Lyme neuroborreliosis remain ill years after treatment
References:
- Hemmer B, Glocker FX, Kaiser R, Lucking CH, Deuschl G. Generalised motor neuron disease as an unusual manifestation of Borrelia burgdorferi infection. J Neurol Neurosurg Psychiatry. 1997;63(2):257-258.
- Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-1444.
- Kanjwal K, Karabin B, Kanjwal Y, Grubb BP. Postural orthostatic tachycardia syndrome following Lyme disease. Cardiol J. 2011;18(1):63-66.
- Agarwal AK, Garg R, Ritch A, Sarkar P. Postural orthostatic tachycardia syndrome. Postgrad Med J. 2007;83(981):478-480.
- Dumic I, Vitorovic D, Spritzer S, Sviggum E, Patel J, Ramanan P. Acute transverse myelitis – A rare clinical manifestation of Lyme neuroborreliosis. IDCases. 2019;15:e00479.
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!