Aiman Sajjad1, Brian Sacks2, Sayyeda Zahra2, Satinderpal Singh3, Alison Walsh2
1Neurology, Lehigh Valley Health Network, 2Lehigh Valley Health Network, 3LVHN Division of Neurology
Background:
Lyme disease, transmitted by the Ixodes species of ticks, is commonly seen in the northern hemisphere. However, radiculitis related to Lyme neuroborreliosis is an uncommon neurological complication of Lyme disease, characterized by inflammation of nerve roots. This clinical presentation can vary, and symptoms may not always follow typical dermatomal patterns. Lyme radiculitis in the sacral dermatomal distribution is extremely rare, and only a few cases have been previously reported.
Design/Methods:
A 30-year-old female with a history of asthma presented with a two-week history of progressive numbness involving the perianal region, labia, and lower buttocks. Patient experienced severe urinary retention prompting evaluation in the Emergency Department. On neurologic examination, there was decreased pain sensation in the vulva and perianal region. MRI lumbar spine revealed enhancement of the conus medullaris and sacral nerve roots. Subsequently, the patient underwent a lumbar puncture. Cerebrospinal fluid analysis showed lymphocytic pleocytosis, consistent with an inflammatory process. Serological testing confirmed a positive diagnosis of Lyme disease. The patient received a four-week course of ceftriaxone, resulting in complete resolution of her symptoms during a follow-up at five weeks.
Conclusions:
Sacral radiculitis is an atypical manifestation of Lyme neuroborreliosis. In our case, it was the first presentation of Lyme disease. Lyme should be considered in patients presenting with sacral radiculitis, particularly in endemic areas. Prompt recognition is vital, as early treatment can prevent long-term nerve damage and complications. Further research is warranted to better understand the pathophysiology of Lyme radiculitis and its varied presentations.