Lyme Disease and Transverse Myelitis: Case Report of Spinal Cord Inflammation
Lyme disease may affect the spinal cord.
Transverse myelitis can appear subacute in children.
Early recognition may improve recovery.
Can Lyme disease trigger inflammation of the spinal cord?
In a pediatric case report, researchers described a child with Lyme-associated transverse myelitis (TM), a neurologic condition involving inflammation within the spinal cord.
The case highlights how Lyme neuroborreliosis may sometimes present differently from classical transverse myelitis and why delayed recognition can complicate diagnosis and treatment.
What Is Transverse Myelitis?
Transverse myelitis (TM) is an inflammatory disorder affecting the spinal cord.
Symptoms may include:
- Weakness
- Sensory changes
- Paresthesias
- Neck or back pain
- Gait abnormalities
- Bladder dysfunction
- Neurologic deficits
Diagnosis typically involves clinical symptoms together with spinal MRI findings and/or cerebrospinal fluid (CSF) abnormalities.
Standard treatment approaches for transverse myelitis often include steroids, intravenous immunoglobulin (IVIG), plasma exchange, or immunomodulatory therapies depending on the underlying cause.
A Pediatric Case of Lyme-Associated Transverse Myelitis
In their article, Case report: Subacute transverse myelitis with gait preservation secondary to Lyme disease and a review of the literature, Colot and colleagues described a 10-year-old boy with:
- Persistent neck pain
- Pain radiating into the upper limbs
- Heaviness in the arms
- Paresthesias in the fingers
- Fatigue
- Headaches
- Fever lasting 11 days
MRI imaging revealed longitudinal extensive transverse myelitis (LETM) involving the cervical spinal cord.
A spinal MRI demonstrated extensive abnormalities extending from C1 to C7.
Why Lyme Disease Was Initially Difficult to Recognize
The patient underwent an extensive evaluation including autoimmune testing, blood serologies, and cerebrospinal fluid analysis.
CSF analysis revealed elevated white blood cells consistent with inflammation.
Initially, the child improved after receiving intravenous methylprednisolone and ceftriaxone.
However, antibiotics were stopped after bacterial cultures remained negative.
Two days later, the patient’s symptoms returned, including recurrent neck pain and laterocollis.
This relapse prompted clinicians to reconsider the diagnosis.
Testing Confirmed Lyme Neuroborreliosis
Because the patient lived in a tick-endemic area, clinicians tested for Lyme disease.
Blood testing and intrathecal Borrelia IgG synthesis later confirmed Lyme-associated transverse myelitis.
The patient also recalled a prior erythematous skin lesion suggestive of erythema migrans several months earlier.
Importantly, he did not recall a tick bite.
This reflects a common challenge in Lyme disease diagnosis, as many patients never remember tick exposure.
How Lyme-Associated Transverse Myelitis May Differ
After reviewing pediatric cases in the literature, the authors suggested several features that may distinguish Lyme-associated transverse myelitis from more classical TM presentations.
According to the authors, Lyme-associated TM may be:
- More subacute in onset
- Predominantly cervical in location
- Associated with preserved gait
- Less likely to involve sphincter dysfunction
- More responsive to prolonged antibiotic therapy
The authors emphasized that severe MRI abnormalities may sometimes appear disproportionate to relatively mild clinical findings.
Why Early Recognition Matters
Delayed recognition of neurologic Lyme disease may complicate recovery.
In this case, the patient ultimately improved after prolonged treatment with ceftriaxone and doxycycline.
After 23 days of antibiotic therapy, the child reportedly made a complete recovery.
The authors concluded that steroids alone did not appear sufficient and emphasized the importance of prolonged antibiotic therapy in Lyme-associated TM.
Learn more about overlapping neurologic symptoms in Neurologic Lyme Disease.
Why Lyme Disease Can Be Missed in Neurologic Cases
Neurologic Lyme disease may mimic autoimmune, infectious, inflammatory, or demyelinating disorders.
Children may not recall a tick bite or develop a classic rash.
Symptoms may evolve gradually or fluctuate over time.
This overlap can complicate diagnosis, particularly when spinal cord inflammation appears before Lyme disease is suspected.
Learn more about delayed diagnosis in Delayed Lyme Disease Diagnosis.
Frequently Asked Questions
Can Lyme disease cause transverse myelitis?
Yes. Lyme neuroborreliosis has been associated with transverse myelitis in rare cases.
What is transverse myelitis?
Transverse myelitis is inflammation involving the spinal cord that may cause weakness, sensory changes, pain, or neurologic dysfunction.
Can children develop neurologic Lyme disease?
Yes. Children with Lyme disease may develop neurologic complications affecting the brain, nerves, or spinal cord.
Do patients always remember a tick bite?
No. Many patients with Lyme disease do not recall a tick bite.
Can MRI findings appear severe even with mild symptoms?
Yes. In Lyme-associated transverse myelitis, MRI abnormalities may sometimes appear more extensive than the clinical presentation suggests.
Clinical Takeaway
Lyme-associated transverse myelitis is uncommon but may present with spinal cord inflammation, neck pain, sensory symptoms, and neurologic abnormalities in children.
Because neurologic Lyme disease can mimic other inflammatory or autoimmune conditions, careful evaluation and early recognition remain important—especially in patients from tick-endemic regions with atypical spinal cord findings.
Related Articles
Listen to the related discussion in Podcast: Transverse Myelitis and Lyme Disease.
Learn more about spinal inflammation in Subacute Transverse Myelitis Caused by Borrelia Infection.
Explore spinal cord complications in Could Lyme Disease Have Led to a Spinal Cord Lesion?.
Review diagnostic complexity in Lyme Disease Misdiagnosis.
Learn more about pediatric presentations in Pediatric Lyme Disease.
References
- Colot C, Adler C, Mignon C, et al. Case report: Subacute transverse myelitis with gait preservation secondary to Lyme disease and a review of the literature. Front Pediatr. 2023;11:1064234.
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 ….