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.

Figure 1

Unilateral knee effusion in a 4-year-old boy presenting to the pediatrician after an unwitnessed fall while playing in the yard.

Figure 2

The classic “bull's-eye” rash or erythema migrans of Lyme disease initially mistaken for a thigh bruise of suspected child abuse.

Figure 3

A radiograph demonstrating the left distal radius revealing a minimally angulated greenstick fracture.

Figure 4

AP and lateral radiographic view of the left knee joint demonstrating joint effusion without presence of fracture.