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The spirochete strains that cause Lyme disease are different between the USA and Europe. This leads not only to a variation in clinical presentations, but it was also thought to alter responsiveness to antibiotic treatment. Unlike in Europe, in the USA there are no head-to-head trials of oral and intravenous antibiotics in the treatment of neuroborreliosis. Guidelines from the American Academy of Neurology (AAN) state that oral doxycycline is probably safe and effective in treating neuroborrliosis without parenchymal involvement, this was mainly extrapolated from European studies data with no reports from North America. To the best of our knowledge, this is the first reported case of Lyme meningo-radiculitis successfully treated with oral doxycycline alone in the USA. This comes in support of the oral doxycycline as an initial and even monotherapy for non-parenchymal Lyme disease of the nervous system in the USA.

Lyme meningo-radiculitis responsive to oral doxycycline therapy in the USA