Lyme Myelopathy: Acute Transverse Myelitis as a Rare but Treatable Complication

Clinical signs and symptoms of acute transverse myelitis (ATM) depend on the region of the
spinal cord involved, explain Kaiser and colleagues in a recent case report,

“Lyme myelopathy: Case report and literature review of a rare but treatable disorder.”

The causes of acute transverse myelitis include demyelinating processes, infections,
autoimmune disorders, malignancies, vascular insults, and nutritional deficiencies,
writes Kaiser.

How Common Is Lyme-Associated Acute Transverse Myelitis?

Lyme disease has been documented as a cause of acute transverse myelitis, but such cases are
rare. Only 25 cases have been reported in the medical literature.

Among these cases, just three patients reported an erythema migrans rash or another rash,
and only five individuals recalled a recent tick bite—highlighting how Lyme myelopathy
can occur without classic early signs of Lyme disease.

Case Report: Lyme Myelopathy in a 56-Year-Old Man

In the journal Multiple Sclerosis and Related Disorders, Kaiser describes the case
of a 56-year-old man who developed acute transverse myelitis as a complication of Lyme
disease.

The patient, an avid gardener living in Pennsylvania, developed severe right-sided back and
flank pain—described as feeling “punched in the kidney”—along with numbness and tingling
that gradually spread across the abdomen.

Clinicians initially suspected herpes zoster without rash. However, the illness progressed
despite seven days of treatment with famciclovir, an antiviral medication.

Signs and Symptoms

The patient’s clinical findings included:

• Abdominal and back muscle spasms
• Tactile allodynia
• Formication (skin-crawling sensation)
• Band-like sensation around the thorax
• Chills
• Urinary hesitancy and incomplete voiding
• Severe pain with writhing movements
• Suspended sensory level between T6–10 on the right and T7–11 on the left, with decreased
  light touch, pinprick, and temperature sensation, plus allodynia
• Hyperreflexia with jaw jerk and +3 bilateral patellar reflexes
• Absent superficial abdominal reflexes

Thoracic MRI findings were consistent with acute transverse myelitis, demonstrating
“an expansile T2 hyperintensity that was longitudinally extensive involving T7–10,”
according to Kaiser.

[bctt tweet=”Authors suggest including Lyme disease testing as part of the work-up for acute transverse myelitis.” username=”DrDanielCameron”]

Diagnosis and Treatment

The patient experienced partial pain relief with corticosteroids and antiviral therapy.

Two weeks after hospital admission, laboratory testing confirmed Lyme disease. The patient
was treated with a three-week course of intravenous ceftriaxone, resulting in near-complete
resolution of symptoms.

The authors recommend that “including Lyme testing as part of the work-up for acute
transverse myelitis may aid in identifying potentially reversible causes of myelopathy.”

“Our patient had a rare presentation of Lyme neuroborreliosis (LNB), namely Lyme myelopathy,
evidenced by myelopathic symptoms and signs, imaging abnormalities of the thoracic spinal
cord, serological evidence of Lyme disease, intrathecal antibody synthesis, and significant
improvement following antibiotic therapy.”

Editor’s note:
This case highlights the importance of recognizing acute transverse myelitis as a potential
neurologic complication of Lyme disease.