Only few cases with sacral
radiculitis due to
infection with Borrelia burgdorferi leading to neurogenic urinary dysfunction have been reported. A 57-year-old male developed urethral
pain and
urinary retention, requiring permanent catheterization. Extensive urological investigations did not reveal a specific cause, which was why
neurogenic bladder dysfunction was suspected. Neurologic exam revealed only mildly reduced tendon reflexes. Cerebral and spinal MRI were noninformative. CSF investigations, however, revealed
pleocytosis, elevated
protein, and
antibodies against Borrelia burgdorferi. Intravenous
ceftriaxone for three weeks resulted in immediate improvement of bladder dysfunction, with continuous decline of residual urine volume and continuous increase of spontaneous urine volume even after removal of the
catheter and initiation of self-catheterization. Sacral
radiculitis due to
infection with Borrelia burgdorferi is a potential cause of detrusor areflexia and urethral, perineal, inguinal, and scrotal
pain and may be misinterpreted as
cystitis or
urethritis.
Ceftriaxone may result in progressive recovery of bladder dysfunction and
pain. Neuroborreliosis may manifest exclusively as neurourological problem.