Rare manifestation of Lyme borreliosis –⁠ encephalomyelitis in a 14-year-old girl

Czech version

Authors: Jitka Bolchová ^1,2; Lada Vilkusová ³; Ivan Peychl ⁴
Authors‘ workplace: Pediatrické oddělení, Fakultní nemocnice Bulovka, Praha ¹; Klinika infekčních nemocí a Dětské oddělení, Fakultní nemocnice Bulovka, 3. lékařská fakulta, Univerzita Karlova, Praha ²; Radiodiagnostické oddělení Fakultní nemocnice Bulovka ³; Pediatrické oddělení Fakultní nemocnice Bulovka, Praha ⁴
Published in: Čes-slov Pediat 2026; 81 (4): 209-213.
Category: Case Report
doi: https://doi.org/10.55095/CSPediatrie2026/018

Overview

Lyme neuroborreliosis represents one of the most common forms of disseminated Borrelia burgdorferi infection in childhood. Its clinical presentation is heterogeneous and most frequently includes lymphocytic meningitis, cranial neuropathies, or radiculitis, while spinal cord involvement is rare. We present a case report of a 14-year-old girl with a subacute onset of headache, general condition impairment, and magnetic resonance imaging evidence of cervical myelitis. The diagnosis of neuroborreliosis was confirmed by cerebrospinal fluid analysis, including demonstration of an intrathecal antibody response and elevated levels of the chemokine CXCL13. Following initiation of targeted antibiotic therapy with ceftriaxone, complete clinical and radiological recovery was achieved.

Keywords:

Lyme neuroborreliosis – magnetic resonance imaging – headache – myelitis – CXCL13

Sources

1. Boele van Hensbroek M, Bruinsma RA, Zomer TP, et al. Clinical manifestations of Lyme neuroborreliosis in children: a review. Eur J Pediatr 2023; 182(5): 1965–76.

2. Christen HJ. Lyme neuroborreliosis in children. Ann Med 1996; 28(3): 235–40.

3. Samkar A, Bruinsma RA, Vermeeren YM, et al. Clinical characteristics of Lyme neuroborreliosis in Dutch children and adults. Eur J Pediatr 2023; 182(3): 1183–89.

4. Knudtzen FC, Eikeland R, Bremell D, et al. Lyme neuroborreliosis with encephalitis; a systematic literature review and a Scandinavian cohort study. Clin Microbiol Infect 2022; 28(5): 649–56.

5. Beuchat I, Dunet V, Meylan P, Du Pasquier R. Late Lyme neuroborreliosis with chronic encephalomyelitis. Neurology 2018; 91(13): 627.

6. Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis, and treatment of Lyme disease. Arthritis Rheumatol 2021; 73(1): 1–12.

7. Meissner HC, Steere AC. Management of pediatric Lyme disease: updates from 2020 Lyme guidelines. Pediatrics 2022; 149(3): e2021054980.

8. American Academy of Pediatrics. Lyme disease. In: Kimberlin DW, Brady MT, Jackson MA, Long SS (eds). Red Book. 31. vyd. 2018 : 515.

9. Halperin JJ, Shapiro ED, Logigian E, et al. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2007; 69(1): 91–102.

10. Behravesh C, Schutze G. Doxycycline can be used in young children without staining teeth. AAP News 2015; 36(5): 16. Dostupné na: https://publications.aap.org/aapnews/article-abstract/36/5/16/24797/Doxycycline-can-be-used-in-young-children-without

11. Rajan AS, Gopal M, Periyathambi M, Kuttiatt VS. Dental safety of short-term doxycycline use in children under 8 years: a systematic review and meta-analysis. Front Pharmacol 2025; 16 : 1646638.

12. Ma K, Lu M, Li H, et al. Incidence and influencing factors of tooth discoloration in children using doxycycline: a meta-analysis. Front Pediatr 2025; 13 : 1644231.