Acute cervical myelomeningitis secondary to Lyme neuroborreliosis

Background: Lyme disease, caused by the bacterium Borrelia burgdorferi , can cause multi-systemic signs and symptoms, including peripheral and central nervous system disease. Lyme neuroborreliosis rarely presents with spinal cord involvement. Case Description: We describe a case of a 62-year-old man presenting with fever, meningeal syndrome, rapidly progressive flaccid tetraplegia with preserved sensory function, and urinary and fecal incontinence. Cervical magnetic resonance imaging (MRI) demonstrated extensive intramedullary T2 hyperintensity associated with diffuse circumferential pachymeningeal enhancement on contrast-enhanced T1-weighted images. Serum and cerebrospinal fluid analyses revealed positive anti- B. burgdorferi immunoglobulin G (IgG) and IgM antibodies, confirming a diagnosis. Conclusion: Lyme neuroborreliosis should be considered in patients presenting with acute myelomeningitis. MRI plays a crucial role in diagnosis, and early recognition is essential to initiate appropriate antibiotic therapy.