Acute transverse myelitis as a manifestation of lyme neuroborreliosis: two cases.

Lyme neuroborreliosis (LNB) is a recognized manifestation of Borrelia burgdorferi infection, although spinal cord involvement is rare and may pose a diagnostic challenge. We report two female patients presenting with subacute myelitis due to LNB. The first patient developed a focal cervical spinal cord lesion, while the second presented with a longitudinally extensive thoracic lesion. In both cases, cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis and intrathecal synthesis of Borrelia burgdorferi-specific antibodies. Corticosteroid therapy was initially administered prior to diagnosis due to suspected inflammatory myelitis. Following microbiological confirmation of LNB, both patients were treated with intravenous ceftriaxone, resulting in marked clinical improvement and regression of radiological findings. One patient later developed recurrent neurological symptoms with MRI signal changes at the same spinal level, without evidence of new lesions. These cases highlight the variability of spinal cord involvement in LNB and the importance of considering infectious etiologies in patients presenting with myelitis.