Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this podcast, I will be discussing the case of a 9-year-old boy who presented with abdominal pain as his first symptom of Lyme disease and the subsequent onset of attention deficit and ataxia (or difficulty in walking).
I first read about this case by Savasta and colleagues in the Italian Journal of Pediatrics.1
There are a growing number of signs and symptoms of Lyme disease in children. Savista and colleagues describe the 9-year-old child as having a one-year history of “abdominal pain, progressive poor scholastic performance and gait disturbance.”
At age 8, the boy had been hospitalized for severe abdominal pain and underwent extensive testing. But results were negative. His abdominal pain remitted over the next two months.
One year later, the boy became ill again with new symptoms. “He experienced learning difficulties with attention deficit and irritability, in addition, he developed difficulty in walking,” wrote the authors. “When he was admitted to our Department he presented with ataxic gait, difficulty in speaking and attention deficit.”
The child was diagnosed with abdominal neuroradiculopathy. “Although not confirmed by nerve conduction studies, the clinical characteristics of the pain, the exclusion of other causes, the diffuse spinal roots enhancement on MRI and the additional confirmation of peripheral neuropathy are highly suggestive for abdominal neuroradiculopathy as symptom of onset of the disease,” the authors wrote.
“We observed ataxic gait, learning difficulties with attention deficit and irritability, signs and symptoms reflecting bacterial involvement of central nervous system,” the authors wrote.
Diagnosis and Treatment
Additional laboratory and radiological findings confirmed the diagnosis of late Lyme disease.
The boy was treated with 3 grams of intravenous ceftriaxone for 3 weeks, followed by an additional 3-week course of oral amoxicillin.
The treatment was prolonged “considering the disseminated and long-lasting illness,” the authors wrote.
They explain that in hindsight, “Indeed, a thorough past medical history collection evidenced that the onset of abdominal pain started 2 weeks after a tick-bite episode occurred during a walk in the wood.”
Three months after treatment, the boy’s gait and scholastic performance had improved and resolved completely after one year. A repeat of his spinal tap showed marked improvements.
The authors concluded the abdominal pain was due to painful radiculopathy. Painful radiculopathy leading to abdominal pain has previously been seen in adults but not children.
They suggest that abdominal radiculitis, “although extremely rare, could be the first manifestation of early Lyme neuroborreliosis in pediatric patients.”
The authors did not address whether the abdominal pain was associated with autonomic dysfunction.
This case report highlights the importance of considering “Lyme disease in the differential diagnosis of abdominal pain of unknown origin in children, especially in countries where the infection is endemic,” the authors wrote.
This podcast addresses the following questions:
- Have you seen abdominal pain from Lyme disease in your practice?
- What types of abdominal pain have you seen in your Lyme disease patients?
- What is abdominal neuroradiculopathy?
- Abdominal pain can have many causes and is quite common in children. So, at what point do you consider Lyme disease in the differential diagnosis of a child with abdominal pain?
- What is the importance of the tick bite?
- What is the significance of the ataxic gait, irritability and learning difficulties?
- Will Lyme disease patients tolerate antibiotics?
Editor’s note: I have had Lyme disease patients with abdominal pain associated with autonomic dysfunction in my practice. 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 as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.
Inside Lyme Podcast Series
This Inside Lyme case series will be discussed on my Facebook and made available on podcast and YouTube. As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.
References:
- Savasta S, Fiorito I, Foiadelli T, et al. Abdominal pain as first manifestation of lyme neuroborreliosis in children, case report and review of literature. Ital J Pediatr. Nov 23 2020;46(1):172. doi:10.1186/s13052-020-00936-y
__________________________
For more on abdominal pain and Lyme:
In 2011, Finnish filmmaker Joonas Berghäll was living his dream, making films about important topics. He went to Kenya to direct a documentary about women’s rights in that country. “I was working outside for three weeks and I felt good and strong,” he remembers.That changed dramatically when he returned to Finland. Within days, he started to experience a cascade of symptoms that hit hard and kept going—for weeks, and then months, and then years.
