Lyme disease in an African American child with Down’s syndrome
Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron discusses a case of disseminated Lyme disease in a child, involving a 3-year-old African American girl with Down syndrome and developmental delays.
The report,
“A case of disseminated Lyme disease in a child with skin of color,”
was published by Bax and colleagues in the journal Pediatric Dermatology.
The child, who had trisomy 21 (Down syndrome) and developmental delays, frequently played outdoors in an area where ticks had been observed.
Early Symptoms of Disseminated Lyme Disease
According to the authors, the child experienced a high fever lasting nine days along with a five-day history of rashes. The rashes were asymptomatic and waxed and waned.
The lesions 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.
Additional symptoms suggested systemic illness. Because the child was unable to verbalize pain, her mother noticed behavioral changes.
“While the patient could not verbalize pain, her mother noted that she was walking less and was not tolerating her leg braces or shoes,” the authors wrote. The child also appeared increasingly fatigued and agitated.
CLICK HERE TO WATCH A VIDEO DISCUSSING THIS CASE
Other Diagnoses Considered
Physicians ruled out several other conditions including COVID-19, multisystem inflammatory syndrome in children (MIS-C), and incomplete Kawasaki syndrome.
“Incomplete Kawasaki syndrome was also considered given her hand and foot erythema, skin lesions, fingertip desquamation, and elevated CRP,” the authors explained.
Laboratory testing ultimately supported the diagnosis of Lyme disease.
The child showed “significant improvement” after completing a 14-day course of amoxicillin.
Diagnostic Challenges in Skin of Color
The authors emphasized the challenges of recognizing Lyme disease in individuals with skin of color,
citing earlier research by Fix and colleagues.
“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,” the authors wrote.
These differences suggest that the classic Lyme disease rash may go unrecognized in patients with darker skin tones until more severe symptoms develop.
Additional Challenges in Children With Developmental Delays
The authors did not address the additional diagnostic challenges posed by Down syndrome and developmental delays.
Children who cannot easily communicate pain or neurologic symptoms may be particularly difficult to evaluate for Lyme disease.
In this case, the presence of disseminated rash, fever, and functional changes helped clinicians reach the correct diagnosis.
Treatment Considerations
The report did not discuss long-term outcomes or potential treatment challenges.
In some cases, Lyme disease patients may also have tick-borne co-infections requiring different therapies. For example, amoxicillin would not be effective for infections such as Anaplasmosis or Babesia.
The following questions are addressed in this podcast episode:
- Have you treated children with Down syndrome and developmental delays for Lyme disease?
- What diagnostic and treatment challenges were present in this case?
- What challenges arise when diagnosing Lyme disease in children and adults with skin of color?
- What has been 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 information and not intended as specific medical advice for any individual patient.
