Can Lyme Disease Cause Lesions on the Spine?

Spinal cord lesions rarely occur in Lyme disease
Weakness and autonomic symptoms may suggest neurologic disease
Careful evaluation may identify competing diagnoses

Can Lyme disease cause lesions on the spine? Although uncommon, neurologic Lyme disease has been associated with spinal cord involvement, including rare cases of longitudinally extensive transverse myelitis (LETM).

In their article Case report: Dueling etiologies: Longitudinally extensive spinal cord lesion mimicking spinal cord infarct with simultaneous positive Lyme serology and amphiphysin antibody.¹ Kalaszi and colleagues describe a patient whose findings raised questions about whether Lyme disease contributed to a severe spinal cord lesion.

Because spinal cord disease has many causes, clinicians often must consider infectious, autoimmune, vascular, inflammatory, and paraneoplastic explanations simultaneously.

These neurologic presentations fall within the broader spectrum of neurologic Lyme disease.

Case Presentation: Weakness and Autonomic Symptoms

The man presented with chest pain followed by right lower limb weakness. His symptoms had been preceded by two weeks of constipation and voiding dysfunction.

He later developed bilateral severe flaccid weakness of the lower extremities, absent knee and ankle reflexes, sensory abnormalities, urinary retention, and reduced anal tone.

The autonomic symptoms were notable because bowel and bladder dysfunction may reflect involvement of spinal pathways and broader patterns of autonomic dysfunction.

MRI Findings Suggested Extensive Spinal Cord Disease

MRI of the brain and entire spine revealed extensive abnormalities.

“Magnetic resonance imaging (MRI) of the brain and the whole spine with contrast revealed an abnormal, increased T2 signal in the anterior aspect of the spinal cord beginning at the T4 level and extending to the conus without associated edema or contrast enhancement,” the authors wrote.

The imaging findings were interpreted as consistent with longitudinally extensive transverse myelitis (LETM), raising concern for autoimmune, infectious, vascular, or paraneoplastic causes.

Can Lyme Disease Cause Spinal Cord Symptoms?

Symptoms from spinal cord disease vary depending on location and severity.

Patients may develop:

• weakness
• bowel or bladder dysfunction
• sensory changes
• difficulty walking
• back pain or limb pain
• abnormal reflexes

The authors noted that approximately 70% of patients with spinal cord infarction report pain before neurologic deficits appear.

The patient also reported a bull’s-eye rash six months before symptom onset and described autonomic symptoms beginning two weeks before his neurologic decline.

Evidence Supporting Lyme Disease

Laboratory testing showed intrathecal immunoglobulin G (IgG) against Borrelia antigens p21 and VlsE.

The presence of intrathecal antibodies increased concern that Lyme disease may have contributed to the patient’s spinal cord syndrome.

These diagnostic complexities may contribute to delayed Lyme disease diagnosis, especially when patients present with uncommon neurologic findings.

Competing Explanations Complicated Diagnosis

Testing also identified amphiphysin antibodies, which are associated with several neurologic syndromes including stiff-person syndrome, dysautonomia, and limbic encephalitis.

The coexistence of positive Lyme testing and amphiphysin antibodies complicated interpretation.

Extensive evaluation including PET imaging did not reveal malignancy or another clear explanation.

This case highlights an important principle: multiple abnormalities may coexist, making it difficult to determine which findings are causal and which are incidental.

Treatment and Recovery

The patient received steroids and three weeks of intravenous ceftriaxone.

Recovery was substantial.

“After 6 weeks, he was able to walk unaided with a stick, and bowel and bladder functions were fully recovered,” the authors wrote.

The improvement following treatment does not prove causality but does raise questions about the contribution of infectious and inflammatory mechanisms.

Frequently Asked Questions

Can Lyme disease cause lesions on the spine?

Rarely. Lyme disease has been associated with spinal cord inflammation and rare cases of transverse myelitis.

Can Lyme disease cause spinal cord symptoms?

Yes. Neurologic Lyme disease may cause weakness, sensory symptoms, gait problems, bowel dysfunction, or bladder dysfunction in uncommon cases.

What is longitudinally extensive transverse myelitis?

LETM is a severe inflammatory spinal cord syndrome involving multiple spinal segments.

Can Lyme disease cause bowel and bladder dysfunction?

Some patients with neurologic involvement or autonomic dysfunction may develop bowel or bladder symptoms.

Can spinal cord lesions have more than one cause?

Yes. Infectious, autoimmune, inflammatory, vascular, and paraneoplastic disorders may overlap.

Clinical Takeaway

Spinal cord lesions are uncommon in Lyme disease and require broad evaluation.

When patients present with weakness, autonomic symptoms, bowel or bladder dysfunction, or extensive spinal cord abnormalities, clinicians may need to consider infectious, inflammatory, and competing neurologic explanations simultaneously.

Related Articles

These articles explore neurologic complications, mechanisms, symptoms, and diagnostic challenges related to Lyme disease.

Persistent Lyme disease mechanisms
Lyme disease symptoms guide
Lyme disease misdiagnosis
Recovery from Lyme disease
Six cases of neuroinvasive Lyme disease

References

1. Kalaszi M, Donlon E, Ahmad MW, Mohamed AS, Boers P. Case report: Dueling etiologies: Longitudinally extensive spinal cord lesion mimicking spinal cord infarct with simultaneous positive Lyme serology and amphiphysin antibody. Front Neurol. 2022;13:905283.
2. Moon J, Lee ST, Shin JW, et al. Non-stiff anti-amphiphysin syndrome: clinical manifestations and outcome after immunotherapy. J Neuroimmunol. 2014;274(1-2):209-214.

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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