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. 
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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- 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