Two children ill with both Lyme disease and Mono

JOIN THE CONVERSATION: Leave your comments below

Welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. I find that the best way to get to know Lyme disease is through reviewing actual cases. In this episode, I will be reviewing two cases involving children who had both Lyme disease and mono.

Koester and colleagues first described this case in the Clinical Medicine & Research in 2018.

Mono and Lyme disease are common diseases and share similar symptoms. What happens when a child living in an area endemic for Lyme disease has both conditions?

Case 1

In the first case, a 5-year-old boy complained of abdominal pain, intermittent fevers, neck pain, fatigue, and sore throat. He had no known tick bite or rash.

The doctors tested the boy for mono and Lyme disease.

After the mono test results came back positive, the boy’s diagnosis of Lyme disease was dismissed. The positive IgM immunoblot (bands 23, 39, 41 kDa) was thought to be a false positive test.

However, 2 days later the boy presented with multiple erythema migrans, typical of early disseminated Lyme disease.

He was prescribed 14 days of amoxicillin. Within 4 days of starting treatment, his symptoms had resolved almost completely.

Case 2

In the second case, an 8-year-old boy developed fevers, headache, sore throat, abdominal pain, fatigue, myalgia, and joint pain. There was no history of a rash or tick bite. Tests for Group A Streptococcus pharyngitis and Mono were negative.

The boy was diagnosed for Lyme disease after testing positive on the enzyme immunoassay (EIA) screening and IgM Western blot.

He was treated with amoxicillin. But one week later, the boy complained of ongoing fevers and worsening abdominal and joint pain.

“Exam and abdominal ultrasound confirmed splenomegaly and lymphadenopathy, but no hepatomegaly,” the authors explain.

Repeat tests indicated the boy was positive for Lyme disease (bands 28, 39, 41, 58, 66, 93 kDa.)

After 21 days of treatment with amoxicillin for Lyme disease, the boy made a complete recovery.  (Note: He did not develop a rash as seen in some Mono patients who are  treated with amoxicillin.)

These are not the only patients who develop both mono and Lyme disease. Koester and colleagues described a study in which 52 patients tested positive for Lyme disease and Mono.

Thoughts on the positive IgM western blot

Some doctors have suggested that a positive IgM Western blot for Lyme disease be dismissed as a false positive test. In the second case, the diagnosis of Lyme disease was confirmed by a positive IgM Western blot test.

Koester and colleagues urged caution in dismissing a positive IgM Western blot result, as this runs the risk of delaying treatment.

This episode addresses the following questions:

How did the doctors diagnose Lyme disease?
What is the importance of IgM and IgM in the first case?
What is mono?
How is Mono diagnosed?
What is the treatment for Mono?
What are the difference between Mono, Epstein Barr Syndrome, and Chronic Fatigue Syndrome?
Why is it important to test for Lyme disease and Mono?
What does Epstein Barr and cytomegalovirus have to do with Lyme disease?
Why is an IgM blood test results for Lyme disease often dismissed and why?
Tell me about the rash that can occur in individuals with Mono that take amoxicillin?
Have you seen mono and Lyme disease at the same time?

Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.