Neck pain in a child with Lyme disease due to radiculoneuritis
Doctors typically look for Bell’s palsy or erythema migrans rash when diagnosing Lyme disease. However, Baker and colleagues described a 10-year-old boy with Lyme disease with neck pain without Bell’s palsy or an erythema migrans rash. [1]
The boy presented with fatigue, posterior lower neck pain, and a low-grade temperature of 100.8 for one day. There was no history of a tick bite, erythema migrans rash, or Bell’s palsy, suggestive of Lyme disease.
There was pain in the soft tissues of the posterior neck and upper back. An Magnetic resonance image (MRI) of the cervical spine with and without gadolinium contrast showed “questionable nerve root enhancement at levels C5-C6 and C6-C7 consistent with radiculitis.”
“The presumptive diagnosis was cervical radiculitis due to viral infection,” wrote the authors in the study entitled “Radiculoneuritis due to Lyme disease in a North American child.”
The boy was discharged from the emergency department pending blood cultures and Lyme disease testing.
Two days later, Lyme disease results were positive by IgG and IgM Western blot. The boy did well after 14 days of doxycycline.
“The emergency medicine specialist should be aware of isolated radiculitis as a presentation of early disseminated Lyme disease in children and test for Lyme disease in these patients,” the authors conclude.
“Lyme neuroborreliosis, classically includes meningitis, cranial neuropathy, and/or radiculoneuritis,” wrote the authors. This case presented only without meningitis or cranial neuropathy. “Isolated radiculoneuritis is associated with a longer delay to receiving antibiotics.”
MRI abnormalities are often not ordered unless ruling out another illness. “MRI must be obtained with contrast to identify the inflammation of radiculoneuritis,” wrote the authors.
“Neuropathic pain should raise suspicion for neurologic manifestations of Lyme disease in North America even in the absence of meningitis and cranial nerve palsy.”¹
A spinal tap is typically normal in patients with neurologic Lyme without meningitis.
Radiculoneuritis is rare in the U.S., wrote the authors. It is more common in Europe and thought to be related to different genospecies.
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References:
- Baker AL, Mannix R, Baker AH. Radiculoneuritis due to Lyme disease in a North American child. Am J Emerg Med. Apr 7 2022;doi:10.1016/j.ajem.2022.03.063
Hannan Ahmad
09/14/2023 (10:40 am)
Peeling back the layers of Lyme disease unveils an intricate tapestry where not every thread adheres to the familiar patterns of Bell’s palsy or the tell-tale rash. The tale of a 10-year-old boy, beset by a shadowy pain in the nape of his neck, leads us down a serpentine path of medical detective work. No tick bite in sight, no erythema migrans rash to point the way—only the subtle whispers of an MRI hinting at radiculitis. In this ever-evolving medical landscape, Lyme disease emerges, not just as an ailment, but as a reminder that diseases, like stories, have multiple narratives. How enlightening to think that amidst the cacophony of symptoms, sometimes the most muted ones, like isolated radiculoneuritis, can herald the most profound revelations. The journey of diagnosis and treatment, as illuminated here, is as much an art as it is a science.
Maureen
09/14/2022 (3:26 pm)
Deal with neck and back pain after months of antibiotics! My spinal tap showed spirochetes I have NeuronLyme. I’m now Chronic. Got bit in the early ‘ops and again in 2014/with multiple coinfections
Sue
09/14/2022 (12:08 pm)
This is so interesting. The same thing happened to me. The most excruciating pain in my neck. I spent 6 weeks seeing different doctors, had MRI’s, took heavy dose pain killers and nothing helped. Finally, my doctor put me on Prednisone because they thought I had PMR. Then, frozen shoulder, back pain, shingles. Finally, after 6 weeks of no sleep a Rheumatologist took a Lyme test and bang, all bands CDC positive. 6 weeks of Doxy, 30 days IV and now I’m left with severe nerve pain and neuropathy on my left side of body. I haven’t found anything to help! One doctor told me Bannwarth syndrome.
Anyone else with similar situation? Any suggestions? I would like to find a LLMD that has experience in the treatment of nerves.
Thank you