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Acute transverse myelitis in Lyme neuroborreliosis

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Abstract

Introduction

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.

Case presentation

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.

Conclusion

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.

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References

  1. Pidcock FS, Krishnan C, Crawfor TO, Salorio CF, Trovato. M, Kerr DA. Acute transverse myelitis in childhood: center-based analysis of 47 cases. Neurology. 2007;68:1474–80.

    Google Scholar 

  2. Defresne P, Hollenberg H, Husson B, et al. Acute transverse myelitis in children: clinical course and prognostic factors. J Child Neurol. 2003;18:401–6.

    Google Scholar 

  3. Jacob A, Weinshenker BG. An approach to the diagnosis of acute transverse myelitis. Semin Neurol. 2008;28:105–20.

    Article  PubMed  Google Scholar 

  4. de Seze J, Lanctin C, Lebrun C, et al. Idiopathic acute transverse myelitis: application of the recent diagnostic criteria. Neurology. 2005;65:1950–3.

    Google Scholar 

  5. Knebusch M, Strassburg HM, Reiners K. Acute transverse myelitis in childhood: nine cases and review of the literature. Dev Med Child Neurol. 1998;40:631–9.

    Article  CAS  PubMed  Google Scholar 

  6. Sellner J, Lüthi N, Schüpbach WMM, et al. Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging and laboratory findings. Spinal Cord. 2009;47:312–7.

    Google Scholar 

  7. Huisman TA, Wohlrab G, Nadal D, Boltshauser E, Martin E. Unusual presentations of neuroborreliosis (Lyme disease) in childhood. J Comput Assist Tomogr. 1999;23:39–42.

    Google Scholar 

  8. Olivares JP, Pallas F, Cecaldi M, Viton JM, et al. Lyme disease presenting as isolated acute urinary retention caused by transverse myelitis: an electrophysiological and urodynamical study. Arch Phys Med Rehabil. 1995;76:1171–2.

    Google Scholar 

  9. Rousseau JJ, Lust C, Zangerlie PF, Bigaigon G. Acute transverse myelitis as presenting neurological feature of Lyme disease. Lancet. 1986;2:1222–3.

    Google Scholar 

  10. Mygland A, Ljøstad U, Fingerle V, Rupprecht T, Schmutzhard E, et al. EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol. 2010; 17:8–16

    Google Scholar 

  11. Meurs L, Labeye, D., Declercq, I., Pieret, F., and Gille M. Acute transverse myelitis as a main manifestation of early stage II neuroborreliosis in two patients. Eur Neurol. 2004;52:186–8.

    Google Scholar 

  12. Christen HJ, Hanefeld, F, Eiffert, H, Thomssen, R. Epidemiology and clinical manifestations of Lyme borreliosis in childhood. A prospective multicentre study with special regard to neuroborreliosis. Acta Paediatr Suppl. 1993;386:1–75.

    Google Scholar 

  13. Blanc F, Jualhac B, Fleury M, et al. Relevance of the antibody index to diagnose Lyme neuroborreliosis among seropositive patients. Neurology. 2007;69:953–8.

    Google Scholar 

  14. Ljostad U, Skarpaas T, Mygland A. Clinical usefulness of intrathecal antibody testing in acute Lyme neuroborreliosis. Eur J Neurol. 2007;14:873–6.

    Article  CAS  PubMed  Google Scholar 

  15. Doja A, Bitnun A., Jones EL, et al. Pediatric Epstein–Barr virus-associated encephalitis: 10-year review. J Child Neurol. 2006;21:385–91.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Neuropaediatrics, Department of Paediatrics, University Children’s Hospital, Inselspital, Bern, Switzerland

    S. Bigi & M. Steinlin

  2. Paediatric Infectious Diseases, Department of Paediatrics, University Children’s Hospital, Inselspital, Bern, Switzerland

    C. Aebi

  3. Neuroradiology, Department of Radiology, University Hospital, Inselspital, Bern, Switzerland

    C. Nauer

  4. Institute of Infectious Diseases, University Hospital, Inselspital, Bern, Switzerland

    S. Bigler

Authors
  1. S. Bigi
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  2. C. Aebi
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  3. C. Nauer
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  4. S. Bigler
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  5. M. Steinlin
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Corresponding author

Correspondence to S. Bigi.

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Bigi, S., Aebi, C., Nauer, C. et al. Acute transverse myelitis in Lyme neuroborreliosis. Infection 38, 413–416 (2010). https://doi.org/10.1007/s15010-010-0028-x

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  • DOI: https://doi.org/10.1007/s15010-010-0028-x

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