• Arianne L Baker, Rebekah Mannix, and Alexandra H Baker.
• Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States of America. Electronic address: arianne.baker@childrens.harvard.edu.
• Am J Emerg Med. 2022 Jul 1; 57: 234.e1-234.e2.

AbstractLyme disease is the most frequently reported vector-borne illness in the United States. It is caused by infection with Borrelia burgdorferi via the bite of an infected blacklegged tick (Ixodes spp.) Lyme disease has three stages: early localized, early disseminated, and late. Early disseminated Lyme disease may include neurologic manifestations such as cranial nerve palsy, meningitis, and radicular pain (also called radiculoneuritis). Isolated radiculoneuritis is a rare presentation of early disseminated Lyme disease and is likely underrecognized. We report a case of isolated Lyme radiculoneuritis in a child in Massachusetts characterized by fever and allodynia of the upper back that was treated in the emergency department. Laboratory investigation demonstrated elevated inflammatory markers and positive Lyme testing. Magnetic resonance imaging with gadolinium contrast revealed nerve root enhancement in C5-C6 and C6-C7. The symptoms resolved with oral doxycycline. Neuropathic pain should raise suspicion for neurologic manifestations of Lyme disease in North America even in the absence of meningitis and cranial nerve palsy. We report how timely recognition of this rare syndrome in North America is important and may prevent progression to late disease.Copyright © 2022 Elsevier Inc. All rights reserved.

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