[Acute Myelitis and Lyme Disease]

Rev Neurol (Paris). 2007 Nov;163(11):1039-47. doi: 10.1016/s0035-3787(07)74176-0.
[Article in French]

Abstract

Introduction: Acute myelitis accounts for 4 to 5 percent of all cases of neuroborreliosis. In the literature, simultaneous spinal MRI and cerebrospinal fluid (CSF) investigations are presented for only 8 cases. We describe here 3 cases of acute Lyme myelitis.

Method: In a cohort of 45 patients with neuroborreliosis, diagnosed between January 1998 and January 2005, 3 had acute myelitis. Clinical, biological and radiological data were studied.

Case reports: The three patients had motor, sensorial and sphincter involvement. Extra-spinal involvement, such as fever and headache for one, facial nerve palsy for the second and subarachnoid hemorrhage for the third, was also noted. Pleocytosis varied from 10 to 520 white cells per mm3. Lyme serology was positive in CSF for all. Intrathecal anti-Borrelia antibody index was positive or intermediate for all three patients. Spinal cord MRI revealed a large hyperintense zone involving more than 3 vertebral segments. Myelitis was central, posterior or transverse in the axial plane. The clinical course was favorable after a three-week course of appropriate antibiotics.

Conclusion: These 3 cases and the others from the literature show the diversity of the clinical and radiological features of acute myelitis: transverse, central or posterior myelitis. Thus, Lyme serology in CSF in indicated for patients presenting acute myelitis, particularly in endemic areas.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Acute Disease
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Antibodies, Bacterial / analysis
  • Antibodies, Bacterial / cerebrospinal fluid
  • Blotting, Western
  • Borrelia burgdorferi / immunology
  • Cohort Studies
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Humans
  • Leukocytosis / etiology
  • Lyme Disease / complications*
  • Lyme Disease / drug therapy
  • Lyme Disease / pathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Myelitis / drug therapy
  • Myelitis / etiology*
  • Myelitis / pathology
  • Myelitis, Transverse / drug therapy
  • Myelitis, Transverse / etiology
  • Myelitis, Transverse / pathology
  • Spinal Cord / pathology

Substances

  • Anti-Bacterial Agents
  • Antibodies, Bacterial