Abdominal pain as first manifestation of lyme neuroborreliosis in children, case report and review of literature
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CASE REPORT
Open Access
Abdominal pain as first manifestation of lyme neuroborreliosis in children, case report and review of literature Salvatore Savasta1, Ivan Fiorito2* , Thomas Foiadelli2, Anna Pichiecchio3, Patrizia Cambieri4, Bianca Mariani4, Piero Marone4 and Gianluigi Marseglia2
Abstract Background: Lyme neuroborreliosis can cause a variety of neurological manifestations. European children usually present facial nerve palsy, other cranial nerve palsies and aseptic meningitis. Case presentation: We 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. Conclusion: This 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. Keywords: Lyme neuroborreliosis, Abdominal pain, Radiculitis, Lyme disease, Radicular pain
Background 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]. LB is endemic in North America, Asia, central and northern Europe and is continually rising in Western Europe [1–3]. Incidence of infection peaks in 5–14 years old children and middle-aged adults (40–50 years old) [3]. Clinically, the illness develops in different sequential stages. The primary stage exhibits a peculiar skin rash (erythema migrans), a painless round shaped rash with slow enlargement that tends to resolve from the center that typically appears seven to 14 days after the bite. Fatigue or headache is often seen at this stage [1]. Blood or * Correspondence: [email protected] 2 Department 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. The secondary stage, that starts from three to 5 weeks after the bite, typically involves the neuronal or the cardiac tissue, usually causing atrioventricular blocks [1, 3]. The third and chronic stage is only rarely reached and is mainly represented by arthritis or late neurological complications [1, 4]. When the Borrelia burgdorferi sensu lato-complex invade the nervous system, the resulting clinical entity is called Lyme neuroborreliosis (LNB) [1, 3, 4]. Neurological symptoms usually occur between one and 12 weeks after the tick bite. Both the peripheral and central nervous systems can be affected by L
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