Clinical, imaging, and biofluid correlates of Lyme polyradiculitis in a case report of neuroborreliosis

Among the causes of ambulatory dysfunction, Lyme polyradiculitis is an uncommon but still essential aetiology to consider given its simple, effective treatment. We present a case of a man with 1 month of worsening bilateral leg paresis, paresthesia, and pain. He recalled no erythema migrans or tick bite. Initial screening showed negative serum Lyme and positive Epstein-Barr Virus testing. At our hospital, MRI revealed polyradiculitis with cauda equina nerve root enhancement. Subsequent serum and cerebrospinal results were positive for Lyme neuroborreliosis. He improved rapidly from a course of doxycycline. This case highlights the importance of timing for Lyme serologies in early neuroborreliosis, as well as converging clinical, radiological, and biofluid testing for diagnosis and management.