When a Teen’s Symptoms Don’t Match Lyme Disease

A 15-year-old student came to my office after months of headaches, fatigue, and joint pain. Her pediatrician had told her family, confidently, “Your symptoms don’t match Lyme.”

But her symptoms began weeks after summer camp in a region known for ticks.

Her MRI was normal. So were her thyroid and vitamin levels. She was told it was “just stress.”
Yet the timing, progression, and symptom pattern told a different story.

“This case reflects a recurring theme in neuropsychiatric Lyme disease in adolescents: when symptoms don’t fit a checklist, infection may be dismissed rather than reconsidered.”

Lyme Disease in Teens Doesn’t Always Look Like Lyme

Adolescents rarely present with textbook adult Lyme symptoms.

Many never notice a bull’s-eye rash.
Some develop fluctuating fatigue, brain fog, or irritability mistaken for anxiety or school stress.
Others experience migrating joint pain, tingling, or headaches without fever.

Standard Lyme testing may be negative early in illness or fail to capture later inflammatory or neurologic presentations, reinforcing false reassurance when symptoms persist.

In CDC analyses, only about 30% of Lyme patients recall a tick bite, meaning most infections go unnoticed. For active teens who spend time outdoors, this represents a major diagnostic blind spot.

Pediatric Lyme Disease: When Age Changes the Pattern

The developing immune and nervous systems can respond differently to infection.

In adolescents, Lyme disease often presents with neuropsychiatric or autonomic symptoms rather than the joint swelling more typical in adults. Some develop features overlapping with:

• PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)

• POTS (Postural Orthostatic Tachycardia Syndrome)

Symptoms may include anxiety, OCD-like behaviors, dizziness, palpitations, rapid heart rate on standing, sudden academic decline, or emotional lability.

In some cases, tick-borne co-infections may further influence symptom severity, duration, or autonomic involvement.

Recognizing these physiologic patterns—rather than labeling them as stress or psychosomatic—is critical for accurate diagnosis and appropriate care.

Other Common Presentations of Lyme Disease in Teens

Lyme disease can affect nearly every system in the body, and in adolescents, symptoms often evolve over time.

Common non-classic presentations include:

1. Migratory musculoskeletal pain, often mistaken for sports injuries or growing pains

2. Severe fatigue or post-exertional malaise, misattributed to burnout

3. Sleep disturbances, including insomnia or reversed sleep cycles

4. Head pressure and light sensitivity, often labeled as migraine

5. Gastrointestinal symptoms linked to autonomic or enteric nerve involvement

6. Cognitive and emotional changes leading to academic decline

7. Menstrual or hormonal irregularities related to inflammatory and autonomic stress

Tracking symptom evolution—rather than relying on a single snapshot—often provides the clearest diagnostic insight in adolescents.

The Great Imitator in Young Patients

Lyme disease can mimic ADHD, chronic fatigue syndrome, depression, fibromyalgia, or primary anxiety disorders in teenagers. Its fluctuating and multisystem nature frequently confounds even experienced clinicians.

A teen who “just seems off” after tick season may not fit a checklist—but the pattern still warrants investigation.

This presentation reflects a broader pattern seen in neuropsychiatric Lyme disease, where infection-driven inflammation disrupts cognition, mood, and autonomic regulation—topics explored throughout this Neuropsychiatric Lyme hub.

Clinical Takeaway

Lyme disease is not a single presentation—it is a multisystem infection with changing faces.

When a teen’s symptoms don’t match the “typical” case, it is time to question the framework, not the patient.

Comprehensive evaluation that includes exposure history, neurologic and autonomic assessment, and consideration of co-infections can prevent years of misunderstanding and inappropriate labeling.

Lyme disease in teens often looks like stress—not infection. But inflammation doesn’t follow the syllabus.”

Related Links

• His Parents Overlooked These Lyme Disease Clues

• POTS : An autonomic disorder in Lyme disease patients