Can Lyme Disease Cause Neck Pain? A Child with Lyme Radiculoneuritis
Neck pain can be an early symptom of Lyme disease.
Neurologic Lyme disease may affect the meninges or cervical nerve roots.
This pediatric case highlights Lyme radiculoneuritis presenting primarily with neck pain.
Lyme disease can cause neck pain, although most cases of neck pain are unrelated to Lyme disease. Neck pain may result from muscle inflammation, Lyme meningitis, or, less commonly, inflammation of the cervical nerve roots known as radiculoneuritis. Patients may experience neck pain, neck stiffness, or both, depending on which tissues are affected. The following case illustrates an uncommon neurologic presentation in a child.
Most patients with neck pain do not have Lyme disease. However, clinicians practicing in endemic areas should consider Lyme disease in patients with unexplained neck pain, particularly when accompanied by fever, neuropathic symptoms, or possible tick exposure. Neck pain may develop during early disseminated Lyme disease, typically days to several weeks after infection. The following pediatric case illustrates how isolated neck pain led to the diagnosis of early disseminated Lyme disease.
Child with neck pain diagnosed with Lyme radiculoneuritis
The boy presented with fatigue, posterior lower neck pain, and a low-grade temperature of 100.8°F for one day. There was no history of a tick bite, erythema migrans rash, or Bell’s palsy suggestive of Lyme disease.
He had pain involving the soft tissues of the posterior neck and upper back. Magnetic resonance imaging (MRI) of the cervical spine with and without gadolinium contrast demonstrated “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 child was discharged from the emergency department while blood cultures and Lyme disease testing were pending.
Two days later, Lyme disease testing returned positive by both IgM and IgG Western blot. Following a 14-day course of doxycycline, the boy recovered well.
“Emergency medicine specialists should be aware of isolated radiculoneuritis as a presentation of early disseminated Lyme disease in children and should test for Lyme disease in these patients,” the authors concluded.
How Lyme disease can cause neck pain
Neck pain associated with Lyme disease may result from several different mechanisms. Early infection can produce muscle aches involving the neck and shoulders. Lyme meningitis may cause headache accompanied by neck stiffness and fever. Less commonly, Lyme disease causes inflammation of the cervical nerve roots, leading to radiculoneuritis (Bannwarth syndrome) and significant neuropathic neck pain.
In this child, Lyme neuroborreliosis presented solely as radiculoneuritis without meningitis or cranial neuropathy. “Lyme neuroborreliosis classically includes meningitis, cranial neuropathy, and/or radiculoneuritis,” the authors explained. Patients with isolated radiculoneuritis may experience delays in diagnosis because the presentation is uncommon in North America.
Additional North American case reports have described severe neck pain and radicular pain as presenting features of Bannwarth syndrome, suggesting this neurologic manifestation may be underrecognized in the United States.
MRI abnormalities may not be identified unless imaging is performed with contrast. “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.”
A lumbar puncture is often normal in patients with neurologic Lyme disease who do not have meningitis, emphasizing that normal cerebrospinal fluid findings do not exclude radiculoneuritis.
Although radiculoneuritis is uncommon in the United States, it is encountered more frequently in Europe, where different Borrelia genospecies are believed to contribute to its higher incidence.
Frequently Asked Questions
Can Lyme disease cause neck pain?
Yes. Lyme disease can cause neck pain through muscle inflammation, Lyme meningitis, or inflammation of the spinal nerve roots (radiculoneuritis). Although most cases of neck pain are unrelated to Lyme disease, clinicians should consider the diagnosis in patients with compatible symptoms and possible tick exposure.
Can Lyme disease cause a stiff neck?
Yes. A stiff neck is a classic symptom of Lyme meningitis. Neck pain without meningitis may also occur due to muscle inflammation or cervical radiculoneuritis.
What is Lyme radiculoneuritis?
Lyme radiculoneuritis is inflammation of the spinal nerve roots caused by Lyme disease. Symptoms may include severe neck or back pain, burning or shooting pain, numbness, tingling, or weakness. It is more common in Europe but is increasingly recognized in North America.
Can neurologic Lyme disease occur without a rash?
Yes. Some patients with neurologic Lyme disease never develop or notice an erythema migrans rash and may not recall a tick bite. Physicians should consider Lyme disease based on the overall clinical presentation.
Clinical Takeaway
Neck pain following a tick bite or during Lyme season should prompt consideration of Lyme disease, particularly when accompanied by fever, headache, neck stiffness, neuropathic pain, or other neurologic symptoms. Although cervical radiculoneuritis is uncommon in North America, this case demonstrates that it may be the primary manifestation of early disseminated Lyme disease, even in the absence of meningitis, Bell’s palsy, an erythema migrans rash, or a known tick bite.
Lyme disease is an uncommon—but important—cause of neck pain that clinicians should keep in mind when evaluating patients in endemic areas, because early recognition and treatment may prevent delays in appropriate antibiotic therapy.
Related Articles
Learn more about the neurologic manifestations of Lyme disease and related diagnostic challenges:
Lyme disease symptoms guide
Podcast: Lumbar puncture not helpful for diagnosing Lyme neuroborreliosis?
Podcast: 43-year-old man with meningitis and radiculitis due to Lyme disease
Persistent Lyme disease: An overview
Lyme disease test accuracy: Understanding the limitations
References:
- Baker AL, Mannix R, Baker AH. Radiculoneuritis due to Lyme disease in a North American child. Am J Emerg Med. 2022. doi:10.1016/j.ajem.2022.03.063.
- Dabiri I, Calvo N, Nauman F, et al. Atypical presentation of Lyme neuroborreliosis related meningitis and radiculitis. Neurol Int. 2019;11(4):8318.
- Omotosho YB, Sherchan R, Ying GW, Shayuk M. A Unique Case of Bannwarth Syndrome in Early Disseminated Lyme Disease. Cureus. 2021;13(4):e14680.
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.