Lyme Arthritis in a Military Dependent Child After Relocation From Japan

Lyme disease is known to be endemic in parts of Japan, yet it is rarely diagnosed. Between
2006 and 2010, only 41 cases of Lyme disease were reported nationwide, according to Soloria
and colleagues.

“Forty-one cases were domestic cases with 19 suspected to have been acquired in Hokkaido,
5 cases in Nagano, and 2 cases each in Kanagawa, Niigata, Gifu, and Fukuoka,” Soloria writes
in the journal Military Medicine.

Case Report: Lyme Arthritis in an Adolescent After International Travel

Two weeks after arriving in the United States from Japan, a 17-year-old boy was evaluated
for possible Lyme arthritis. He presented with a six-week history of progressive swelling
of his right knee, which began while he was still living in Japan.

The diagnosis of Lyme arthritis was confirmed through aspiration of the joint effusion and
supportive laboratory testing. Notably, clinicians were uncertain where the infection had
been acquired.

“It is conceivable that he was bitten by a Lyme-infected tick in Japan, as his home there
was adjacent to a wooded area,” Soloria explains.

[bctt tweet=”This case highlights the importance of obtaining a thorough travel history. A military dependent child was diagnosed with Lyme arthritis after relocating from Japan.” username=”DrDanielCameron”]

However, Soloria also notes that “it is very possible that he acquired this infection
during travel to the northeastern United States the year prior to complaint of his
symptoms.”

Treatment and Outcome

The adolescent was treated with a four-week course of oral doxycycline and responded well
to therapy, with resolution of symptoms.

Implications for Military Families and Clinicians

The authors emphasize the unique risks faced by military-dependent children, particularly
those who relocate internationally. An estimated 42,000 military dependents live on bases
throughout Japan, placing a large pediatric population at potential risk for tick-borne
illnesses.

“This case highlights the importance of obtaining a thorough travel history from military
members and their families who frequently relocate due to military orders,” Soloria
writes.

In addition, “military medical providers must be aware of tropical and travel-related
illnesses and infections that may have been acquired at a prior duty station.”

This case underscores the need for clinicians to consider Lyme disease in patients with
compatible symptoms—even when exposure may have occurred outside traditionally recognized
endemic regions.