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Case report
Lyme neuroborreliosis presenting as spinal myoclonus
  1. Xena Li1,
  2. Aaron Kirschner1,
  3. Mary Metrie1 and
  4. Mark Loeb1,2
  1. 1Medicine, McMaster University, Hamilton, Ontario, Canada
  2. 2Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Mark Loeb; loebm{at}


Early neurological Lyme disease (neuroborreliosis) typically presents with well-recognised neurological syndromes. Spinal myoclonus is however a rare manifestation of neuroborreliosis. We present the case of a man who developed spinal myoclonus 3 weeks after returning from the Czech Republic where he developed erythema migrans on his arm following multiple tick exposures. Spinal fluid analysis showed a pleocytosis and MRI showed enhancement at C5-C6. His serology was positive for IgM antibodies to Borrelia afzelli. He was successfully treated with ceftriaxone and doxycycline with improvement of his spinal myoclonus and radiculitis. We conclude that early Lyme neuroborreliosis may present with uncommon neurological manifestations and so a high degree of suspicion is needed.

  • infections
  • neurology (drugs and medicines)
  • infection (neurology)

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  • Contributors XL and ML developed the concept for the work. XL, AK, MM and ML acquired and interpreted the data. XL drafted initial manuscript. ML, AK and MM revised the manuscript. XL, ML, AK and MM gave final approval and agree to be accountable.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.