Lyme disease symptoms in toddler attributed to child abuse

Welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this episode, I will be discussing a case involving a toddler with Lyme disease whose symptoms were mistakenly attributed to child abuse.

The case was first described by Pan and colleagues in the journal Case Reports in Orthopedics.¹

A 4-year-old boy was evaluated by his pediatrician for an unwitnessed fall while playing in the yard. According to Pan et al., the child presented with “a swollen right knee, a tender left radius without deformity, and what was initially interpreted as a large bruise on the buttock.”

The pediatrician also noted a greenstick fracture of the toddler’s forearm and a knee effusion and referred the patient to an orthopedic surgeon.

However, “Due to the constellation of findings and lack of a witness to the fall, the pediatrician also reported the child to the local County Social Services for Children and Youth due to possible non-accidental trauma,” writes Pan.

Bruise or Bull’s-eye rash?

The child was temporarily placed into foster care. The orthopedist treated the toddler’s forearm with a cast. The child was afebrile with a minimally tender knee and was able to bear weigh.

Upon closer inspection, the bruising on the child’s buttocks was consistent with a Bull’s-eye rash. The mother did not recall a tick bite but the family lived in a rural wooded area of Pennsylvania, an area endemic for Lyme disease.

Lyme disease tests were positive and the toddler was treated with 30 days of oral amoxicillin.

“Children and Youth ended their investigation of the family, and five days later, they concluded that the child had Lyme disease with an unrelated radius fracture,” writes Pan.

Underreporting and overreporting of child abuse

“Increased public awareness of child abuse along with lack of adequate training for mandated reports can result in overreporting of child abuse cases,” the authors point out.

In fact, “less than 1 of 7 cases reported by professionals end up as confirmed abuse.”

“We report a case of Lyme disease with an unrelated distal radius fracture mistakenly reported for child abuse.”

The authors highlight potential problems with overreporting of child abuse:

“Families and individuals under investigation for child abuse often face social isolation which can exacerbate the risk factors for abuse.”

“Families are subjected to investigation, interrogation, separation, and punishment after a report is made.”

“Lastly, the strategy in investigating child abuse arguably deprive accused individuals of their constitutional right to maintain innocence until proven guilty.”

The following questions are addressed in this podcast episode:  

1. How often are Lyme disease cases misdiagnosed?
2. Have you seen Lyme disease cases referred to social services?
3. How typical was the boy’s Lyme disease presentation?
4. What is synovitis?
5. Was the treatment appropriate?
6. What are additional concerns for a young boy with Lyme disease?

Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.