Can Lyme Disease Be Mistaken for Child Abuse?
A Lyme disease rash was mistaken for a bruise
A child was temporarily removed from his family
Recognition of Lyme disease changed the diagnosis
Can Lyme disease be mistaken for child abuse? A 2021 case report describes a 4-year-old boy whose Lyme disease rash and swollen knee initially raised concerns about abuse, leading to temporary foster care before erythema migrans and Lyme disease were recognized.
Some medical cases stay with us long after we read them. One such case—published by Pan and colleagues in 2021—stands out for how quickly a misunderstanding escalated into a family crisis.
The child lived in an area where Lyme disease is common, making tick-borne illness an important consideration during the evaluation.
How a Lyme Disease Rash Was Mistaken for a Bruise
The case involved a 4-year-old boy evaluated after an unwitnessed fall while playing outdoors. He had a swollen right knee, tenderness over his left forearm, and a large mark on his buttock that resembled a bruise. Imaging confirmed a minimally angulated greenstick fracture of the distal radius.
Because no adult had witnessed the fall and the combination of findings raised concern for possible nonaccidental trauma, the pediatrician reported the case to local social services. The child was temporarily placed in foster care while the evaluation continued.
The fracture required appropriate care. However, closer examination by an orthopedic specialist revealed that the skin lesion was not a typical bruise. Its appearance was consistent with erythema migrans, a characteristic rash associated with Lyme disease.
Lyme disease testing was positive. The medical team concluded that the child had Lyme disease with an unrelated radius fracture.
The child was treated with a 30-day course of oral amoxicillin. His knee swelling and rash resolved, the investigation was closed, and he was reunited with his family five days later.
Why Lyme Disease Can Be Misdiagnosed in Young Children
Young children may be unable to explain when their symptoms began, whether they noticed a tick, or whether a skin lesion has changed over time.
Lyme disease in children may present with limping, refusal to bear weight, irritability, fatigue, joint swelling, or an expanding skin lesion.
Erythema migrans may also appear in locations caregivers do not routinely inspect, including the buttocks, groin, scalp, and areas near the waistband.
Depending on its appearance and location, an erythema migrans rash may resemble bruising, cellulitis, an insect bite, or another skin condition. It does not always have the classic bull’s-eye appearance. Learn more about how Lyme disease rashes can be misdiagnosed.
Lyme disease is therefore among the many conditions that may contribute to delayed diagnosis or misdiagnosis, particularly in children. Learn more about misdiagnosis and delayed diagnosis in Lyme disease.
Lyme Arthritis in Children
The swollen knee in this case was another important clinical clue.
Knee swelling is one of the most common manifestations of Lyme arthritis and may occur even when pain is relatively mild.
Children with Lyme arthritis often present with swelling involving a single large joint, particularly the knee. Because the swelling may occur without severe pain or fever, the diagnosis can sometimes be overlooked.
Additional information can be found in our guide to pediatric Lyme disease.
Balancing Child Protection and Medical Diagnosis
Suspected child abuse must always be taken seriously and handled according to applicable reporting requirements. This process can protect vulnerable children.
At the same time, a thorough medical evaluation remains essential, especially when some physical findings do not fit the expected pattern of trauma. In this case, the fracture required appropriate evaluation, while the erythema migrans rash and knee swelling ultimately pointed to Lyme disease.
This case illustrates how disease-related findings and signs of possible maltreatment can occasionally overlap. Maintaining a broad differential diagnosis can protect children while also reducing the risk of unnecessary family disruption.
Lessons From This Lyme Disease Misdiagnosis
This child’s story demonstrates how Lyme disease mistaken for child abuse can rapidly escalate into an investigation and family separation.
It also illustrates how quickly the course of care can change once the clinical findings are reconsidered and Lyme disease is recognized.
Considering Lyme disease in children with an unexplained rash, joint swelling, or mobility problems may help prevent delayed diagnosis, particularly in endemic areas.
Frequently Asked Questions
Can Lyme disease be mistaken for child abuse?
Yes. In rare cases, findings such as an erythema migrans rash or unexplained joint swelling may initially resemble signs of injury. This case involved Lyme disease as well as an unrelated forearm fracture.
Can a Lyme disease rash look like a bruise?
Yes. Although erythema migrans is often described as a bull’s-eye rash, it can have different appearances and may occasionally resemble a bruise or another skin condition.
Can Lyme disease cause knee swelling in children?
Yes. Lyme arthritis commonly affects the knee and may produce substantial swelling even when pain is limited.
What are signs of Lyme disease in young children?
Signs may include an expanding rash, limping, refusal to walk, fatigue, irritability, joint swelling, headache, and fever. Symptoms vary, and not every child develops or notices a rash.
Clinical Takeaway
This case report illustrates how Lyme disease can occasionally complicate an evaluation for suspected child abuse when an erythema migrans rash resembles bruising and Lyme arthritis produces unexplained joint swelling.
Recognizing the child’s Lyme disease did not negate the need to evaluate the fracture; it allowed clinicians to distinguish an unrelated injury from infection-related findings and reunite the child with his family.
Related Articles
Lyme Disease Symptoms Guide
Early Symptoms of Lyme Disease
Lyme Disease Test Accuracy
References
- Pan T, Nasreddine A, Trivellas M, Hennrikus WL. Lyme Disease Misinterpreted as Child Abuse. Case Rep Orthop. 2021;2021:6665935.
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
I can’t even begin to imagine what this family went through. It’s brave of the authors to publish this. One also wonders how the clinicians felt, doing what they were obligated to do legally and ethically, only to discover later a rather “obscure” reason was what was responsible for all this. If this poor kid relapses at some point in the future, the family will probably be much, much more hesitant to present, making everything all that much worse. Brutal.
You’re right — it’s almost impossible to imagine what this family went through. Everyone was doing what they thought was right, yet the real cause was something easily missed. What breaks my heart is that experiences like this can make families afraid to seek help again if symptoms return. No one should ever have to face that twice.