DOI: 10.12890/2026_007103

A rare presentation of Lyme neuroborreliosis: multifocal cervical and thoracic transverse myelitis-a case report

Authors

  • Elmedina Shatri Medical Faculty, University of Pristina, Pristina, Kosovo
  • Rrezarta Tërnava Medical Faculty, University of Pristina, Pristina, Kosovo
  • Antoneta Gërdovci Medical Faculty, University of Pristina, Pristina, Kosovo
  • Ilir Tolaj Department of Infectious Diseases, Medical Faculty, Pristina, Kosovo
  • Gëzim Morina Department of Infectious Diseases, University Clinical Centre, Pristina, Kosovo

rrezarta.ternava@student.uni-pr.edu

Keywords

Transverse myelitis, Lyme disease, neuroborreliosis, multifocal spinal cord lesions

Abstract

Background: Spinal cord involvement in Lyme disease is an uncommon manifestation of neuroborreliosis, with myelitis representing a rare clinical entity. Multifocal transverse, non-contiguous spinal cord involvement remains particularly rare and is insufficiently characterized in the existing literature.
Case report: We report the case of a 40-year-old previously healthy woman who presented with rapidly progressive paraparesis, ascending sensory deficits, and bladder and bowel dysfunction consistent with acute-subacute inflammatory myelopathy. Spinal magnetic resonance imaging (MRI) demonstrated multifocal non-contiguous inflammatory lesions involving the cervical and thoracic spinal cord. Extensive microbiological and serological investigations excluded alternative infectious aetiologies. Brain MRI showed no evidence of demyelinating disease. Despite clinically significant spinal cord inflammation, cerebrospinal fluid (CSF) analysis revealed neither pleocytosis nor elevated protein concentration. However, Borrelia-specific IgM antibodies were detected in both serum and CSF, and a positive Borrelia-specific antibody index (AI 3.07) confirmed intrathecal anti-Borrelia antibody synthesis, establishing the diagnosis of Lyme neuroborreliosis-associated myelitis. The patient subsequently demonstrated marked neurological improvement following targeted treatment with intravenous ceftriaxone combined with corticosteroids and supportive therapy.
Conclusion: This case significantly expands the recognized spectrum of spinal cord involvement in Lyme disease–associated neuroborreliosis by delineating an extremely rare multifocal presentation, thereby emphasizing the critical importance of recognizing atypical manifestations in the diagnostic evaluation of inflammatory myelopathies.

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References

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Published

2026-07-09

Issue

Vol. 13 No. 7 (2026)

Categories

How to Cite

1.
Shatri E, Tërnava R, Gërdovci A, Tolaj I, Morina G. A rare presentation of Lyme neuroborreliosis: multifocal cervical and thoracic transverse myelitis-a case report. EJCRIM [Internet]. 2026 Jul. 9 [cited 2026 Nov. 3];13(7). Available from: https://ejcrim.com/index.php/ejcrim/article/view/7103

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