Neck Pain in a Child with Lyme Disease: A Missed Neurologic Sign
Neck pain may signal neurologic Lyme disease
Classic symptoms may be absent
Early signs are often missed in children
Lyme disease neck pain in a child may be an early neurologic sign that is easily overlooked—especially when classic features such as rash or facial palsy are absent.
The boy presented with fatigue, posterior lower neck pain, and a low-grade fever of 100.8°F for one day. There was no history of a tick bite, erythema migrans rash, or Bell’s palsy.
There was pain in the soft tissues of the posterior neck and upper back. An 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, results were positive by IgG and IgM Western blot. The boy recovered after 14 days of doxycycline.
Isolated Radiculoneuritis Without Classic Signs
This case highlights that Lyme disease can present with isolated neurologic symptoms.
Lyme neuroborreliosis classically includes meningitis, cranial neuropathy, and radiculoneuritis. However, this child presented without meningitis or cranial nerve involvement.
Such presentations are associated with delays in diagnosis—a pattern also seen in Lyme disease misdiagnosis, where atypical symptoms may not prompt early testing.
The Role of MRI
MRI findings may be subtle and are often missed if contrast is not used.
The authors emphasize that MRI with contrast is necessary to detect nerve root inflammation. Without contrast, the diagnostic findings in this case may have been overlooked.
Why This Case Matters
Neuropathic pain—especially when unexplained—should raise suspicion for neurologic Lyme disease in children.
This is particularly important when symptoms do not match routine musculoskeletal patterns described in the Lyme disease symptoms guide.
When pain does not match imaging or expected patterns, infection-driven nerve inflammation should be considered.
Clinical Perspective
A normal spinal tap does not rule out Lyme neuroborreliosis in patients without meningitis.
Radiculoneuritis is more commonly reported in Europe but does occur in North America. In children, it may present as isolated neck pain—unlikely to prompt Lyme testing unless specifically considered.
When neurologic symptoms follow outdoor exposure, clinicians should consider Lyme disease even in the absence of classic signs.
Frequently Asked Questions
Can Lyme disease cause neck pain in children?
Yes. Lyme disease can inflame cervical nerve roots (radiculoneuritis), leading to neck and upper back pain.
Does Lyme disease require a rash or tick bite history?
No. This child had no rash or known tick bite. Symptoms can occur without classic early signs.
Is radiculoneuritis common in Lyme disease?
It is more common in European cases but does occur in North America and may be underrecognized.
Does a normal spinal tap rule out Lyme disease?
No. In neurologic Lyme disease without meningitis, spinal tap results are often normal.
Did the child recover with treatment?
Yes. Symptoms resolved after antibiotic treatment.
References
- Baker AL, Mannix R, Baker AH. Radiculoneuritis due to Lyme disease in a North American child. Am J Emerg Med. 2022.
Related Reading
- Lyme Disease Pain: Why It Moves and What Helps
- Lyme Disease Back Pain
- Burning Pain With Normal EMG
- Lyme Disease Neuropathy
- Knee Pain and Lyme Disease
- Autonomic Dysfunction in Lyme Disease
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
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
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
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.