Because of the broken wrist, the child was referred to an orthopedic surgeon, who put a cast on it. Then the specialist looked at the “bruise” and observed that it might be an erythema migrans (EM) rash, indicative of Lyme disease.

They ordered a Lyme test, which was positive, and started antibiotic treatment. After FIVE DAYS, the boy was reunited with his parents.

Why did this happen?

According to the case report, the child was prescribed 30 days of oral amoxicillin, after which the knee effusion and the rash cleared up. After five weeks in a cast, the wrist injury resolved as well.

Here are several important points:

• Pennsylvania has one of the highest rates of Lyme disease in the United States.
• Summertime is peak season for ticks and their diseases.
• A swollen knee is a well-known sign of Lyme disease, especially in children.
• An EM rash doesn’t have to look like a well-defined bull’s-eye. (In fact, it often has no central clearing and could look like a bruise. But the EM shown in that photo HAS central clearing, thus looking less like a bruise.)

So why the heck didn’t it occur to this Pennsylvania pediatrician that a child with a swollen knee and a skin lesion with central clearing might have Lyme disease? And maybe the fact that his leg hurt was why he fell and broke his wrist? Why was the doctor so quick to call child protection authorities before exploring other possibilities?

Of course, it’s important for medical personnel to be on the alert for possible child abuse. I would never argue otherwise.

But as the authors of the case report conclude: Physicians should use common sense and employ a systematic approach to evaluate children with suspected abuse.

Let’s hear it for common sense!

Medical personal need Lyme education

I can only imagine how traumatizing this whole event was for this poor little boy and his family. It underscores yet again the need for widespread education about Lyme disease.

Pediatricians, ER personnel and other front line medical workers must know enough to suspect Lyme disease when two clear signs of the infection are staring them in the face. (And even when it’s less obvious.)

Click to read the entire case report here

The authors noted that the boy’s treatment followed the IDSA’s recommendation of 30 days of antibiotics. Although they report that the knee and the rash resolved, if it were my child, I wouldn’t leave it there. Ideally, he should be evaluated by a Lyme-literate physician to see if further treatment is warranted, and whether there are unrecognized co-infections.

TOUCHED BY LYME is written by Dorothy Kupcha Leland, LymeDisease.org’s Vice-president and Director of Communications. She is co-author of When Your Child Has Lyme Disease: A Parent’s Survival Guide. Contact her at dleland@lymedisease.org.