Disclosures: Patrick T. Davis: No financial relationships or conflicts of interest
Case Description: The patient presented with bilateral lower back and leg pain, numbness, and weakness that had progressed for one week following a three-day febrile illness two weeks prior. On exam, his gait was asymmetric. Lumbar range of motion was limited in all directions due to pain. Muscle strength testing showed bilateral 4/5 strength with dorsiflexion of the foot and 4-/5 strength with extension of the big toe, right slightly weaker than left. Sitting slump maneuver was positive bilaterally. Examination of deep tendon reflexes revealed 0-1/4 bilateral patellar and achilles reflexes. Sensation was subjectively decreased bilaterally in an L5/S1 distribution. He was recommended for MRI showing severe central spinal canal stenosis with bilateral lateral recess stenosis at L4-L5. Fluoroscopically guided, contrast enhanced, caudal epidural steroid injection resulted in increased pain after one to two days. Due to lack of improvement and the post-infectious nature of his condition, laboratory work-up was initiated including a Lyme antibody profile. Results were positive for Lyme IgG and IgM on Western blot. The patient was treated with two courses of oral doxycycline. During this time he underwent an EMG demonstrating acute on chronic, severe, combined axonal and demyelinating, sensorimotor polyneuropathy in the bilateral lower extremities. Following the antibiotics, he demonstrated full motor recovery and symptomatic relief following treatment.
Setting: Outpatient
Patient: 70-year-old male Assessment/
Results: Accurate diagnosis of the patient’s underlying condition resulted in the appropriate treatment with doxycycline. The patient experienced a significant reduction in pain and was able to return to normal function.
Discussion: This is a rare case of Lyme radiculopathy presenting with bilateral symptoms that has been documented to occur in only 3% of CDC documented Lyme cases.
Conclusion: Lyme radiculoneuropathy should be considered in patients in endemic areas in Spring and Autumn when presenting with truncal or limb pain without an apparent mechanical cause.
Level of Evidence: Level V
To cite this abstract in AMA style:
Davis PT, Radecki J. The Great Masquerader: Lyme Disease Mimicking Radiculopathy [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/the-great-masquerader-lyme-disease-mimicking-radiculopathy/. Accessed May 30, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-great-masquerader-lyme-disease-mimicking-radiculopathy/