Late Lyme neuroborreliosis with predominant myelitis in a patient with neuropsychiatric presentation: a case report.

Background: Late Lyme neuroborreliosis (LNB) can develop gradually over months or years. Diagnosis can be very difficult, resulting in treatment delay and higher risk of sequelae. By publishing this case report, we hope to highlight the difficulties associated with Lyme disease in a patient with assumed psychosomatic disorder. Case Description: We present the case of a 54-year-old patient with late LNB presenting predominantly with myelitis. The patient suffered from symptoms for more than 1.5 years before a diagnosis was made through testing of cerebrospinal fluid (CSF) samples and magnetic resonance imaging (MRI) of the spine. MRI revealed signs of a long ranging myelopathy with a dull signal alteration in the spinal cord. CSF samples displayed lympho-monocytic pleocytosis, plasma cells and Borrelia-specific intrathecal antibodies. The long delay before diagnosis and ultimately the start of antibiotic treatment was likely influenced by the initial attribution of symptoms to psychosomatic causes. Conclusions: LNB presents with variable and often nonspecific symptoms, making diagnosis difficult. Early warning signs may be overlooked, especially in patients with comorbidities or psychiatric history. Treatment delay increases the risk of residual symptoms. This case highlights the difficulties surrounding LNB and underlines the importance of an individualized and thorough diagnostic approach, regardless of pre-existing conditions.