Abdominal Pain as a First Symptom of Lyme Disease in a Child

Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this podcast, I discuss the case of a 9-year-old boy whose first symptom of Lyme disease was abdominal pain, followed by attention deficit and ataxia (difficulty walking).

I first read about this case by Savasta and colleagues in the Italian Journal of Pediatrics.¹

There are a growing number of recognized Lyme disease symptoms in children. Savasta and colleagues describe a 9-year-old child with a one-year history of abdominal pain, progressive poor school performance, and gait disturbance.

At age 8, the boy had been hospitalized for severe abdominal pain and underwent extensive testing. However, the results were negative. His abdominal pain resolved over the next two months.

One year later, the boy developed new symptoms. “He experienced learning difficulties with attention deficit and irritability and developed difficulty walking,” the authors wrote.

When he was admitted for evaluation, he presented with ataxic gait, difficulty speaking, and attention deficit.

Abdominal Neuroradiculopathy

The child was diagnosed with abdominal neuroradiculopathy. Although not confirmed by nerve conduction studies, the clinical features of the pain, exclusion of other causes, spinal nerve root enhancement on MRI, and peripheral neuropathy supported the diagnosis.

The authors noted that the boy showed signs consistent with central nervous system involvement including ataxic gait, learning difficulties, and irritability.

Diagnosis and Treatment

Additional laboratory and radiologic findings confirmed the diagnosis of late Lyme disease.

The boy was treated with 3 grams of intravenous ceftriaxone for three weeks, followed by three weeks of oral amoxicillin.

The treatment course was extended because the illness appeared disseminated and long-standing.

In hindsight, a careful history revealed that the abdominal pain had started two weeks after a tick bite that occurred during a walk in the woods.

Three months after treatment the boy’s gait and school performance improved. His symptoms resolved completely after one year. A repeat spinal tap showed marked improvement.

Why This Case Matters

The authors concluded that the abdominal pain was due to painful radiculopathy. Painful radiculopathy causing abdominal pain has previously been described in adults with Lyme disease but rarely in children.

They suggest abdominal radiculitis, although uncommon, could be the first manifestation of Lyme neuroborreliosis in pediatric patients.

The authors did not address whether the abdominal pain might also have been related to autonomic dysfunction.

This case highlights the importance of considering Lyme disease in the differential diagnosis of unexplained abdominal pain in children living in endemic regions.

Clinical Insight

In my clinical practice, I have seen Lyme disease patients whose abdominal pain appeared related to autonomic dysfunction or nerve irritation. When abdominal pain occurs alongside neurologic symptoms, Lyme disease should be considered—particularly in endemic areas.

This Podcast Addresses the Following Questions

1. Have you seen abdominal pain from Lyme disease in your practice?
2. What types of abdominal pain have you seen in Lyme disease patients?
3. What is abdominal neuroradiculopathy?
4. When should Lyme disease be considered in the differential diagnosis of abdominal pain in children?
5. What role does a tick bite history play in diagnosis?
6. What is the significance of ataxic gait, irritability, and learning difficulties?
7. Will Lyme disease patients tolerate antibiotics?

Editor’s note: I have had Lyme disease patients with abdominal pain associated with autonomic dysfunction in my practice.

Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in the show notes and on my website at DanielCameronMD.com.

Please remember that the advice given is general and not intended as specific advice for any individual patient. If you require medical advice, please consult an experienced professional.