Acute transverse myelitis in Lyme neuroborreliosis.
BACKGROUND
Acute transverse myelitis (ATM) is a rare disorder (1-8 new cases per million of population per year), with 20% of all cases occurring in patients younger than 18 years of age. Diagnosis requires clinical symptoms and evidence of inflammation within the spinal cord (cerebrospinal fluid and/or magnetic resonance imaging). ATM due to neuroborreliosis typically presents with impressive clinical manifestations.


METHODS
Here we present a case of Lyme neuroborreliosis-associated ATM with severe MRI and CSF findings, but surprisingly few clinical manifestations and late conversion of the immunoglobulin G CSF/blood index of Borrelia burgdorferi sensu lato.


CONCLUSIONS
Clinical symptoms and signs of neuroborrelial ATM may be minimal, even in cases with severe involvement of the spine, as shown by imaging studies. The CSF/blood index can be negative in the early stages and does not exclude Lyme neuroborreliosis; if there is strong clinical suspicion of Lyme neuroborreliosis, appropriate treatment should be started and the CSF/blood index repeated to confirm the diagnosis.
Bigi
S
S
Neuropaediatrics, Department of Paediatrics, University Children's Hospital, Inselspital, Bern, Switzerland. Sandra.bigi@insel.ch
Aebi
C
C
Nauer
C
C
Bigler
S
S
Steinlin
M
M
D000293:Adolescent; D025065:Borrelia burgdorferi / Q000302:isolation & purification; D006801:Humans; D020852:Lyme Neuroborreliosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology; D008297:Male; D009188:Myelitis, Transverse / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000382:microbiology; D011859:Radiography