Lyme disease in an African American child with Down’s syndrome

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Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron discusses the case of a 3-year-old African American child with Down’s syndrome, developmental delays and disseminated Lyme disease.

“A case of disseminated Lyme disease in a child with skin of color” was published by Bax and colleagues in the journal Pediatric Dermatology.¹ The child, who had trisomy 21 (Down’s syndrome) and developmental delays, had a history of playing outside in an area where ticks were observed.

According to the authors, the young girl had experienced a high fever for 9 days and had a 5-day history of rashes. The rashes were asymptomatic and would wax and wane. They consisted of “scattered ill-defined 2-5 cm erythematous patches on the back, abdomen, and upper and lower extremities,” a pattern consistent with disseminated Lyme disease.

There were other manifestations of Lyme disease, as well. “While the patient could not verbalize pain, her mother noted that she was walking less and was not tolerating her leg braces or shoes,”  wrote the authors. “She also appeared increasingly fatigued and agitated.”

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The doctors ruled out COVID-19, inflammatory syndrome (MIS-C), and Incomplete Kawasaki’s syndrome.  “Incomplete Kawasaki’s syndrome was also considered given her hand/foot erythema, skin lesions, fingertip desquamation, and elevated CRP.”

Laboratory tests supported the diagnosis of Lyme disease. The child showed “significant improvement” with 14 days of amoxicillin.

Challenges raised by this case

The authors addressed the challenges in diagnosing Lyme disease in people of color, citing a study by Fix and colleagues.²

“African Americans in Borrelia burgdorferi-endemic regions have been reported to have higher rates of extracutaneous sequelae, such as arthritis, and lower rates of erythema migrans compared with Caucasians, suggesting that the characteristic rash in skin of color may go unrecognized until more severe symptoms manifest,” the authors wrote.

They did not address the challenges in diagnosing Lyme disease in people with Down’s syndrome and development delays. Fortunately, the 3-year-old toddler presented with a disseminate Lyme disease rash, symptoms, and functional problems, which led to an accurate diagnosis. This would have undoubtedly been more difficult without these findings. 

Treatment 

The authors did not discuss long-term outcomes or treatment concerns. In some cases, Lyme disease patients may have a co-infection which would require different types of treatment. For instance, amoxicillin would not be effective in treating Anaplasmosis and Babesia.

The following questions are addressed in this Podcast episode:

1. Have you treated children with Down’s syndrome and developmental delays for Lyme disease?
2. What were the diagnostic and treatment challenges in working with this child?
3. Have you also treated children and adults of color? If so, what diagnostic and treatment challenges do they pose?
4. Tell me about your experience with Lyme disease in children on the autism spectrum.

Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.