Child with Lyme disease diagnosed with radiculopathy

A 10-year-old boy presented with fatigue, posterior lower neck pain, and a low-grade fever of 100.8. “The soft tissues of the posterior neck and upper back were tender with allodynia,” wrote Baker and colleagues in the American Journal of Emergency Medicine.²

They added, the Magnetic Resonance Imaging (MRI) of the cervical spine showed “questionable” nerve root enhancement at levels C5-C6 and C6-C7 consistent with radiculitis. The child was discharged from the emergency room with a diagnosis of cervical radiculitis due to viral infection.

Two days later, the child was diagnosed with Lyme disease with a positive IgM and IgG western blot test. The patient’s symptoms resolved following treatment with oral doxycycline.

The authors pointed out that radiculoneuritis due to Lyme disease is not new. “In US children, meningitis and cranial nerve palsy are relatively common in neuroborreliosis, while radiculoneuritis is rare,” wrote the authors.²

They added, “Neuroborreliosis is easier to recognize when facial nerve palsy or meningitis are present with radiculitis since these are classically associated with Lyme.”

“Any patient with painful radiculitis and plausible exposure to potentially infected ticks should have Lyme testing,” the authors concluded.