Lyme myelopathy: Case report and literature review of a rare but treatable disorder

•The spectrum of disorders associated with transverse myelitis is broad.•In developed countries, most infectious causes of transverse myelitis are viral.•Lyme disease is a rare, but treatable cause of acute transverse myelitis.•Lyme serologies should be performed in otherwise unexplained transverse myelitis. The differential diagnosis for transverse myelitis is extensive, and the prognosis is highly variable depending on the etiology. We describe a rare case of a 56-year-old previously healthy male who presented with thoracic paresthesias and hyperesthesias involving the T6-11 dermatomes several weeks after a febrile illness. A thoracic MRI demonstrated a T7-10 transverse myelitis, and an exhaustive evaluation revealed neuroborreliosis. His symptoms improved significantly after an initial steroid course and 21 day course of ceftriaxone. We review neuroborreliosis and summarize the features of 23 previously reported cases of Lyme myelopathy. Although Lyme myelopathy is rare, including Lyme in the differential diagnosis of an acute transverse myelitis work up is important in endemic regions, as it is a potentially reversible disorder with a generally good prognosis when appropriately treated with antibiotics.