Lyme Disease Misinterpreted as Child Abuse

Abstract

Child abuse is one of the most common causes for child fatality in the United States. Inaccurate reporting of child abuse combined with scarcity of resources for child abuse evaluations can lead to unintended consequences for children and their families. The differential diagnosis of child abuse is varied. To our knowledge, there are no reports in the literature on Lyme disease mimicking child abuse. The current study presents the case of a child from an endemic area for Lyme disease presenting with skin bruising, fracture, and swollen knee. The child was reported for child abuse by the pediatrician and then referred to the orthopaedic surgeon for fracture care.

Bone pathology mimicking non-accidental injury in a child – Bewildered by bones, case report and review of the literature

“…Although there are several cases of bone pathologies mimicking NAI, in assortment, the number of cases is astonishingly less excluding the metabolic and nutritional bone disorders. Osteogenesis imperfecta (OI) [ 10 ], Langerhans cell histiocytosis [ 11 ], congenital syphilis [ 12 ], Caffey disease [ 7 ], Lyme disease, osteomyelitis [ 13 ], Mccune Albright syndrome [ 14 ] have been reported in the literature as unusual conditions leading to pathological fractures in children mimicking NAI. To the best of our knowledge, this is the first case of osteofibrous dysplasia (OFD) presented in this regard.…”

A Multispecialty Approach to the Identification and Diagnosis of Nonaccidental Trauma in Children

“…Similarly, a situation of NAT misdiagnosis can occur in the case of Lyme Disease; the typical bull’s-eye rash or erythema migrans seen in such a scenario can be mistaken for an abusive lesion (Figure 19 ) [ 160 ]. Langerhans cell histiocytosis is another acquired medical condition that presents signs such as skull fracture, erythema, and erosion in labia majora which can easily be misinterpreted as evidence of child maltreatment [ 161 ].…”