Can Lyme Disease Cause Stomach Pain? (Even in Children)
Stomach pain is common.
Lyme disease is often overlooked.
Sometimes, they are connected.
Lyme disease stomach pain is not the most common symptom—but it can occur.
When abdominal pain has no clear cause, Lyme disease may be part of the differential diagnosis.
Lyme disease in children may occur without a rash, particularly in neurologic cases.
Can Lyme Disease Cause Stomach Pain?
Yes, Lyme disease can cause stomach or abdominal pain—although it is not the most common symptom.
In some cases, the pain is caused by nerve involvement (radiculopathy) rather than a primary gastrointestinal problem.
This type of pain may occur without a rash and can be mistaken for other conditions.
Abdominal Pain as an Early Symptom of Lyme Disease
In a case reported by Savasta and colleagues, a 9-year-old boy presented with a one-year history of abdominal pain, followed by declining school performance and difficulty walking. :contentReference[oaicite:0]{index=0}
At age 8, he had been hospitalized for severe abdominal pain.
Extensive testing was performed—but results were negative.
The pain eventually improved, but no clear diagnosis was made.
New Symptoms Raise Concern
One year later, the child developed new neurological symptoms.
- Attention difficulties
- Irritability
- Ataxic gait (difficulty walking)
- Speech difficulties
This shift—from abdominal pain to neurological symptoms—provided an important clinical clue.
Neurologic Lyme disease can present in stages—further complicating early recognition.
Imaging and clinical findings suggested involvement of the nervous system.
When Lyme Disease Affects the Nervous System
The child was diagnosed with abdominal neuroradiculopathy—a form of nerve root inflammation affecting the abdomen.
This type of pain can mimic gastrointestinal disease.
Although more commonly described in adults, this presentation is rare in children.
It reflects involvement of the nervous system in Lyme disease (neuroborreliosis).
Diagnosis and Treatment
Additional testing confirmed the diagnosis of Lyme disease.
The child was treated with:
- 3 weeks of intravenous ceftriaxone
- Followed by 3 weeks of oral amoxicillin
The extended treatment course reflected the duration and severity of symptoms.
Over time, his gait, cognitive function, and school performance improved.
By one year, his symptoms had resolved.
The Missed Clue: A Tick Bite
In retrospect, the onset of abdominal pain began two weeks after a tick bite.
This history was not initially recognized as significant.
Delayed recognition is common when Lyme disease presents without typical symptoms such as a rash.
Why Lyme Disease Can Be Missed in Children
Abdominal pain is a common complaint in pediatric patients.
When testing is negative, Lyme disease may not be considered—especially without a rash.
This case highlights how Lyme disease can present with:
- Unexplained abdominal pain
- Cognitive or behavioral changes
- Gait abnormalities
These symptoms may appear separately over time, making diagnosis more difficult.
Clinical Takeaway
Lyme disease can present with stomach or abdominal pain in children—particularly when the nervous system is involved.
When abdominal pain is unexplained and accompanied by neurological or behavioral changes, Lyme disease should be considered.
Early recognition may prevent prolonged illness and unnecessary testing.
Related Reading
- Lyme disease symptoms guide
- Pediatric Lyme disease overview
- Autonomic dysfunction and Lyme disease
- Why Lyme symptoms come and go
Reference
- Savasta S, Fiorito I, Foiadelli T, et al. Abdominal pain as first manifestation of Lyme neuroborreliosis in children. Ital J Pediatr. 2020.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
