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832 Acute Transverse Myelitis in a Pediatric Case of Lyme Disease

Background and Aim A broad range of neurologic disorders have been described in children with Lyme disease. In contrast, there are few reports of transverse myelitis in pediatric Lyme disease patients. Case Report A 12-old girl admitted with the complaints of weakness in legs, sensory loss in lower limb, and backache for 10 days. Mental status, cranial nerve, and upper-extremity motor and sensory examinations produced normal results. The strength in his iliopsoas and hamstring muscles was scored 2/5. Deep tendon reflexes were absent in both lower extremities. Babinski’s signs were not noted. The Romberg sign was present. Magnetic resonans imaging (MRI) of the spinal cord revealed enhancing T2 hyperintensity within the spinal cord, from T10-L1. (Figure 1). Cerebrospinal fluid (CSF) showed no pleocytosis and normal protein and glucose concentrations. The CSF did not show oligoclonal banding and immunglobulin (Ig)G index was normal. Serum serologic evaluation of Borrelia burgdorferi was positive for IgM but negative for IgG. CSF serologic evaluation was negative (both ELISA and Western blot).The patient was diagnosed as manifesting acute transverse myelitis. He was treated with intravenous methylprednisolone pulse therapy (1000 mg/day for 5 consecutive days), followed by oral prednisolone (1 mg/kg per day). After the start of steroid therapy, the patient showed gradual clinical improvement and was able to walk on the 30th day of illness. We also administered doxycycline 4 mg/kg per day for 14-days for borreliosis. Conclusion This case serves as a reminder that acute transverse myelitis can be a rare clinical manifestation of Lyme disease. Abstract 832 Figure 1