Post by Admin/ Traveler on Jan 11, 2019 20:59:28 GMT
Acute transverse myelitis – A rare clinical manifestation of Lyme neuroborreliosis
Abstract
Acute transverse myelitis (ATM) is a rare, potentially devastating neurological syndrome that has variety of causes, infectious being one of them. Lyme disease (LD) is the most common vector borne zoonosis in the United States (U.S.). While neurologic complications of LD are common, acute transverse myelitis is an exceedingly rare complication.
We present a case of a previously healthy 25-year-old man who presented with secondary erythema migrans, aseptic meningitis and clinical features of transverse myelitis including bilateral lower extremity motor and sensory deficits manifesting as weakness and numbness, urinary retention and constipation. Despite negative serum antibodies against Borrelia burgdoferi, cerebrospinal fluid (CSF) was positive for Borrelia burgdorferi PCR.
Following treatment with methylprednisolone and ceftriaxone, he attained complete recovery apart from neurogenic bladder necessitating intermittent self-catheterization. We report rare manifestation of a common disease and emphasize the importance of considering LD in the differential diagnosis of acute transverse myelitis, particularly in residents of endemic areas.
Case presentation
A previously healthy 25-year-old man presented with inability to urinate and frequent falls associated with bilateral lower extremity weakness and numbness. His symptoms began approximately two weeks prior to presentation when he developed a headache and noticed a red circumferential rash approximately 10 cm in diameter on his left thigh. The headache was frontal in location, mild, intermittent and did not increase in severity over the next two weeks. The rash was red, circular, non-pruriticand disappeared approximately a week before his admission to hospital. At around the same time as the rash disappeared, he developed neck stiffness and subjective fevers with chills but did not have photophobia, nausea or vomiting. Five days prior to admission, he developed urinary retention as well as progressive numbness and weakness in his lower extremities. Sensory deficit initially manifested as left foot numbness and progressed bilaterally in ascending, band-like fashion up to the upper thorax right below the nipple line anteriorly and below the shoulder blades posteriorly. Additionally, he also developed constipation and had been unable to defecate for a few days prior to admission. As a result of bilateral leg weakness and gait instability, he sustained a few falls without major injuries. He denied any joint pain or swelling.
Abstract
Acute transverse myelitis (ATM) is a rare, potentially devastating neurological syndrome that has variety of causes, infectious being one of them. Lyme disease (LD) is the most common vector borne zoonosis in the United States (U.S.). While neurologic complications of LD are common, acute transverse myelitis is an exceedingly rare complication.
We present a case of a previously healthy 25-year-old man who presented with secondary erythema migrans, aseptic meningitis and clinical features of transverse myelitis including bilateral lower extremity motor and sensory deficits manifesting as weakness and numbness, urinary retention and constipation. Despite negative serum antibodies against Borrelia burgdoferi, cerebrospinal fluid (CSF) was positive for Borrelia burgdorferi PCR.
Following treatment with methylprednisolone and ceftriaxone, he attained complete recovery apart from neurogenic bladder necessitating intermittent self-catheterization. We report rare manifestation of a common disease and emphasize the importance of considering LD in the differential diagnosis of acute transverse myelitis, particularly in residents of endemic areas.
Case presentation
A previously healthy 25-year-old man presented with inability to urinate and frequent falls associated with bilateral lower extremity weakness and numbness. His symptoms began approximately two weeks prior to presentation when he developed a headache and noticed a red circumferential rash approximately 10 cm in diameter on his left thigh. The headache was frontal in location, mild, intermittent and did not increase in severity over the next two weeks. The rash was red, circular, non-pruriticand disappeared approximately a week before his admission to hospital. At around the same time as the rash disappeared, he developed neck stiffness and subjective fevers with chills but did not have photophobia, nausea or vomiting. Five days prior to admission, he developed urinary retention as well as progressive numbness and weakness in his lower extremities. Sensory deficit initially manifested as left foot numbness and progressed bilaterally in ascending, band-like fashion up to the upper thorax right below the nipple line anteriorly and below the shoulder blades posteriorly. Additionally, he also developed constipation and had been unable to defecate for a few days prior to admission. As a result of bilateral leg weakness and gait instability, he sustained a few falls without major injuries. He denied any joint pain or swelling.