Subacute transverse myelitis with optic symptoms in neuroborreliosis: a case report

Mikolaj Opielka,Anna Starzynska,Bartosz Kamil Sobocki,Witold Opielka

doi:10.1186/s12883-020-01816-y

Mikolaj Opielka, Anna Starzynska + Show 2 more

Open Access

https://doi.org/10.1186/s12883-020-01816-y

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Abstract

BackgroundSubacute transverse myelitis is one of the late manifestations of neuroborreliosis with only a few cases described to the present day.Case presentationWe present magnetic resonance imaging, cerebrospinal fluid, and electroneurography findings of a young female patient suffering from neuroborreliosis-associated transverse myelitis with a wide constellation of symptoms including papilloedema. Magnetic resonance imaging of the cervical spine has shown an enlargement of the spinal cord in the mid-cervical region. Cerebrospinal fluid findings included lymphocytic pleocytosis, increased levels of anti - Borrelia antibodies, and increased intrathecal anti -Borrelia antibody index. Following the 28-day course of intravenous ceftriaxone, the patient attained complete recovery.ConclusionsSubacute transverse myelitis in the course of neuroborreliosis should be considered in the differential diagnosis of patients with abnormal magnetic resonance scans of the spinal cord, lymphocytic pleocytosis, and intrathecal antibody production, especially in the tick-endemic areas, even if the tick bite was not reported. Infrequent accompanying symptoms such as papilloedema are diagnostically challenging and cannot be treated as clinching evidence.

Highlights

Subacute transverse myelitis is one of the late manifestations of neuroborreliosis with only a few cases described to the present day.Case presentation: We present magnetic resonance imaging, cerebrospinal fluid, and electroneurography findings of a young female patient suffering from neuroborreliosis-associated transverse myelitis with a wide constellation of symptoms including papilloedema
Subacute transverse myelitis in the course of neuroborreliosis should be considered in the differential diagnosis of patients with abnormal magnetic resonance scans of the spinal cord, lymphocytic pleocytosis, and intrathecal antibody production, especially in the tick-endemic areas, even if the tick bite was not reported
Because of the low sensitivity of culture and polymerase chain reaction (PCR), the preferred diagnostic factor is the measurement of IgM and IgG antibody production against Borrelia in serum and cerebrospinal fluid (CSF) by enzyme-linked immunosorbent assay (ELISA)

Summary

Conclusions

Subacute transverse myelitis in the course of neuroborreliosis should be considered in the differential diagnosis of patients with abnormal magnetic resonance scans of the spinal cord, lymphocytic pleocytosis, and intrathecal antibody production, especially in the tick-endemic areas, even if the tick bite was not reported.

Findings

Background

Discussion and conclusion