Meningomyelitis due to Borrelia burgdorferi leading to isolated chronic progressive myelopathy

A 29 year old male patient was admitted to our hospital because of spastic paraparesis of the legs which had developed during the previous six months. In addition, he complained about urgency and frequent micturition. There w ere neither sensory deficits, nor clinical signs of meningitis or radiculit is. While blood chemistry including vitamin B-12 was normal, examination of the cerebrospinal fluid revealed marked pleocytosis (predominantly neutrop hil granulocytes) and significant elevation of total protein. Magnet resona nce imaging of the cervical spinal cord detected an space occupying hyperin tense intramedullary lesion. The meninges of this area showed intense contr ast enhancement. Confirmed by serological test, the diagnosis or neuroborre liosis, leading to the clinical syndrome of isolated meningomyelitis was ma de. Upon treatment with antibiotics; the patient recovered nearly completel y within half a year. We discuss the present case including the differentia l diagnosis.