Abdominal pain as first manifestation of lyme neuroborreliosis in children, case report and review of literature

Salvatore Savasta,Gianluigi Marseglia,Anna Pichiecchio,Patrizia Cambieri,Ivan Fiorito,Piero Marone,Thomas Foiadelli,Bianca Mariani

doi:10.1186/s13052-020-00936-y

Abstract

BackgroundLyme neuroborreliosis can cause a variety of neurological manifestations. European children usually present facial nerve palsy, other cranial nerve palsies and aseptic meningitis.Case presentationWe hereby report a case of Lyme neuroborreliosis in a 9-year-old boy with abdominal pain as first symptom and subsequent onset of attention deficit and ataxia. Diagnosis was made by detection of specific antibody in both serum and cerebrospinal fluid with neuro-radiological images suggestive for this infectious disease. A 12-months follow-up was performed during which no relevant neurological sequelae were revealed.ConclusionThis case report shows that abdominal radiculitis, although extremely rare, could be the first manifestation of early Lyme neuroborreliosis in pediatric patients. Pediatricians must consider Lyme disease in the differential diagnosis of abdominal pain of unknown origin in children, especially in countries where the infection is endemic.

Highlights

Lyme neuroborreliosis can cause a variety of neurological manifestations
Lyme borreliosis (LB) is a clinically heterogeneous bacterial zoonosis caused by the spirochete Borrelia burgdorferi (Bb), that is transmitted to humans by a tick bite [1]
In Europe, the most common strain associated to Lyme neuroborreliosis (LNB) is Borrelia garinii, and the disease usually presents with radicular pain and meningeal signs [5,6,7, 13]

Summary

Introduction

Lyme neuroborreliosis can cause a variety of neurological manifestations. European children usually present facial nerve palsy, other cranial nerve palsies and aseptic meningitis. * Correspondence: ivan.fiorito01@universitadipavia.it 2Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy Full list of author information is available at the end of the article peripheral nerve dissemination of the bacterium lead to the subsequent stages, with various signs and symptoms. Painful meningoradiculitis (Bannwarth’s syndrome) is the most common presentation of LNB in Europe [1, 3, 6, 7].

Results

Conclusion