The boy presented with fatigue, posterior lower neck pain, and a low-grade temperature of 100.8 for one day. There was no history of a tick bite, erythema migrans rash, or Bell’s palsy suggestive of Lyme disease.

There was pain in the soft tissues of the posterior neck and upper back. An MRI of the cervical spine with and without gadolinium contrast showed questionable nerve root enhancement at levels C5-C6 and C6-C7 consistent with radiculitis.

The presumptive diagnosis was cervical radiculitis due to viral infection, wrote the authors in the study entitled “Radiculoneuritis due to Lyme disease in a North American child.”

The boy was discharged from the emergency department pending blood cultures and Lyme disease testing. Two days later, Lyme disease results were positive by IgG and IgM Western blot. The boy did well after 14 days of doxycycline.

Isolated Radiculoneuritis Without Classic Signs

The authors conclude that emergency medicine specialists should be aware of isolated radiculitis as a presentation of early disseminated Lyme disease in children — and test for Lyme disease in these patients.

Lyme neuroborreliosis classically includes meningitis, cranial neuropathy, and radiculoneuritis. This case presented without meningitis or cranial neuropathy. The authors note that isolated radiculoneuritis is associated with a longer delay to receiving antibiotics.

The Role of MRI

MRI abnormalities are often not ordered unless ruling out another illness. The authors emphasize that MRI must be obtained with contrast to identify the inflammation of radiculoneuritis. Without contrast, the nerve root enhancement that confirmed the diagnosis in this case may have been missed entirely.

Clinical Perspective

Neuropathic pain should raise suspicion for neurologic manifestations of Lyme disease in North America even in the absence of meningitis and cranial nerve palsy. A spinal tap is typically normal in patients with neurologic Lyme without meningitis — meaning a normal lumbar puncture does not rule out the diagnosis.

Radiculoneuritis is rare in the U.S. and more common in Europe, thought to be related to different genospecies. But as this case demonstrates, it occurs in North American children and can present as isolated neck pain — a symptom unlikely to prompt Lyme testing unless the clinician considers it.

This case reinforces a broader pattern seen across Lyme disease presentations: when pain doesn’t match imaging and standard explanations fall short, infection-driven nerve inflammation deserves consideration — regardless of the patient’s age.

Frequently Asked Questions

Can Lyme disease cause neck pain in children?
Yes. Lyme disease can inflame cervical nerve roots — a condition called radiculoneuritis — producing neck and upper back pain that mimics viral or mechanical causes.

Does neck pain from Lyme disease require a rash or tick bite history?
No. This child had no recalled tick bite, no rash, and no Bell’s palsy. Isolated neck pain was the primary presenting symptom.

Is radiculoneuritis common in Lyme disease?
It is more commonly reported in European cases but does occur in North America. Isolated radiculoneuritis without meningitis or cranial neuropathy is particularly easy to miss.

Does a normal spinal tap rule out Lyme neuroborreliosis?
No. In patients with neurologic Lyme disease without meningitis, spinal tap results are typically normal.

Did the child recover with treatment?
Yes. After 14 days of doxycycline, the boy’s symptoms resolved.

References

1. Baker AL, Mannix R, Baker AH. Radiculoneuritis due to Lyme disease in a North American child. Am J Emerg Med. 2022;doi:10.1016/j.ajem.2022.03.063.

Related Reading

• Lyme Disease Pain: Why It Moves and What Helps
• Lyme Disease Back Pain: A Mystery Solved After 9 Months
• Burning Pain With Normal EMG: Understanding the Disconnect
• Lyme Disease Neuropathy: Symptoms and What Causes It
• Knee Pain and Lyme Disease: Why It’s Often Missed
• Autonomic Dysfunction in Lyme Disease