When Lyme Disease Mistaken for Child Abuse Sets a Crisis in Motion

Some medical cases stay with us long after we read them. One such case—published by Pan and colleagues in 2021—still stands out for how quickly Lyme disease mistaken for child abuse escalated into a family crisis.

The case involved a toddler brought to the hospital with a swollen knee, a fractured arm, and a dark mark on his buttock that resembled a bruise. No adult had witnessed the injury. There was no clear explanation for the findings. Following standard procedure, clinicians reported suspected abuse, and the child was placed in protective custody.

At that moment, the story seemed tragically straightforward: unexplained injuries, concerning physical findings, and a need to protect a vulnerable child. But the truth was far more complex.

The Subtle Clue That Changed Everything

As the medical team assessed the child, one clinician noticed something unusual about the so-called bruise. It did not behave like a typical traumatic lesion. Its edges formed a faint ring. The center appeared slightly lighter. Over time, the mark seemed to expand outward instead of fading.

These were not the characteristics of a bruise. They were the characteristics of erythema migrans, the hallmark rash of Lyme disease.

Serologic testing was ordered. The Lyme test was positive.

The child was started on amoxicillin, and the response was swift. The knee swelling eased. His comfort improved. The rash began to resolve. Within five days, he was reunited with his family.

Even though the case was older, reading it years later had a profound impact on me. It highlighted how easily an infection can be mistaken for inflicted injury in children who cannot explain what they feel.

Why This Case Was So Easy to Misinterpret

Toddlers rarely provide a clear medical history. They cannot describe the onset of pain, whether a tick was present, or whether a rash is new or expanding. Their symptoms are often nonspecific: irritability, reduced limb use, fatigue, or refusal to walk.

Lyme disease also has a talent for hiding in the areas caregivers rarely see. The buttocks, groin, and diaper region are common sites for erythema migrans in young children, and rashes in these areas are often misidentified.

A Necessary Balance: Protecting Children and Recognizing Illness

Any suspicion of child abuse must always be taken seriously and reported immediately. This process saves lives. But equally important is a thorough and nuanced medical evaluation, especially when the physical findings do not follow the expected patterns of trauma.

This case is a reminder that the line between medical disease and suspected maltreatment can be thin—so thin that a single missed detail can separate a child from his family. And a single correct diagnosis can bring them back together.

What This Case Teaches Us

This child’s story shows how Lyme disease mistaken for child abuse can rapidly escalate into legal action, emotional distress, and unnecessary separation. It also shows how quickly everything can be reversed once Lyme disease is recognized.

Awareness protects children. Considering Lyme protects families.

Have you or your child ever experienced a misdiagnosis before Lyme was discovered? Share your story below.

Source

Pan T, Nasreddine A, Trivellas M, Hennrikus WL. Lyme Disease Misinterpreted as Child Abuse. Case Rep Orthop. 2021;2021:6665935.

Resources

1. Case Rep Orthop. A Multispecialty Approach to the Identification and Diagnosis of Nonaccidental Trauma in Children
2. CDC. Recognizing medical child abuse in children presenting with chronic pain
3. Dr. Daniel Cameron: Lyme Science Blog. Lyme disease symptoms in toddler attributed to child abuse
4. Dr. Daniel Cameron: Lyme Science Blog. Study finds misdiagnosis and delayed diagnosis common for Lyme disease patients