What question did this study set out to answer?

To highlight the presentation and diagnosis of acute cervical myelomeningitis due to Lyme neuroborreliosis.

May 10, 2026Open Access

Acute cervical myelomeningitis secondary to Lyme neuroborreliosis

Key Points

To highlight the presentation and diagnosis of acute cervical myelomeningitis due to Lyme neuroborreliosis.
Detailed case description of a 62-year-old man with clinical symptoms including fever and tetraplegia.
Magnetic resonance imaging (MRI) identified spinal cord abnormalities with contrast-enhanced images.
Serum and cerebrospinal fluid analyses documented positive anti-B. burgdorferi IgG and IgM antibodies.
MRI indicated extensive intramedullary T2 hyperintensity and pachymeningeal enhancement.
Positive serum and cerebrospinal fluid antibody tests confirmed Lyme neuroborreliosis diagnosis.
Immediate recognition led to early intervention with appropriate antibiotic treatment.

Abstract

Background: Lyme disease, caused by the bacterium Borrelia burgdorferi , can cause multi-systemic signs and symptoms, including peripheral and central nervous system disease. Lyme neuroborreliosis rarely presents with spinal cord involvement. Case Description: We describe a case of a 62-year-old man presenting with fever, meningeal syndrome, rapidly progressive flaccid tetraplegia with preserved sensory function, and urinary and fecal incontinence. Cervical magnetic resonance imaging (MRI) demonstrated extensive intramedullary T2 hyperintensity associated with diffuse circumferential pachymeningeal enhancement on contrast-enhanced T1-weighted images. Serum and cerebrospinal fluid analyses revealed positive anti- B. burgdorferi immunoglobulin G (IgG) and IgM antibodies, confirming a diagnosis. Conclusion: Lyme neuroborreliosis should be considered in patients presenting with acute myelomeningitis. MRI plays a crucial role in diagnosis, and early recognition is essential to initiate appropriate antibiotic therapy.

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