- •Although nervous system involvement frequently complicates Lyme disease, transverse myelitis is rare
- •Our case report had features of an acute, asymmetric cervical radiculitis followed by a lower-motor-neuron pattern bibrachial paresis with minimal sensory changes
- •- The presentation was due to a multi-segmental, contiguous, cervical radiculopoliomyelitis-myelitis in the ventral gray matter and nearby long-tracts
- •Given the propensity for radiculitis, B. burgdorferi may access the central nervous system by tracking along peripheral nerves into the meninges
Nervous system involvement occurs in up to 15% of patients with Lyme disease, most commonly manifested as cranial neuropathy, lymphocytic meningitis, and or radiculoneuritis. We describe a patient with subacute radiculopoliomyelitis-myelitis matching the selective involvement of the anterior horns and roots of the cervical spinal cord seen on MRI and on electrodiagnostic studies. We demonstrate positive CSF Lyme antibodies and document a near-complete recovery with antibiotics. This case highlights the importance of recognizing an atypical presentation of Lyme disease in the setting of initial radiculitis and or myelitis, particularly given the potential for favorable outcomes with appropriate treatment.
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Published online: April 17, 2017
Accepted: April 14, 2017
Received in revised form: April 11, 2017
Received: October 26, 2016
© 2017 Published by Elsevier B.V.