A 6 year old boy seen this month after recovery from severe neurological complications of Lyme disease prompts this report to alert pediatricians and neurologists to the increase in incidence of this seasonal infectious disease, especially among campers in the United States, Europe, and Australia.

The patient whose case was reported from St. Helier Hospital, Carshalton, Surrey, presented 6 months ago with headache, drowsiness, vomiting, photophobia, and neck stiffness. He was afebrile and had papilledema and Babinski signs. The CT was normal and the CSF was compatible with viral meningo-encephalitis. His condition rapidly deteriorated and bulbar, 6th and 7th nerve palsies, and spastic paralysis developed. Borrelia burgdorferi serology was positive and IgG and IgM titers were elevated in the serum but not in the CSF. Benzylpenicillin IV in high doses for 14 days resulted in slow but complete recovery. [1]

COMMENT: This patient lacked the history of tick bite, fever, arthralgia, and characteristic rash, erythema chronica migrans. He had been camping in France 4 months before and had been close to deer in Richmond Park 5 months before the onset of symptoms. About 15% of patients with Lyme disease develop neurological problems. A triad of meningo-encephalitis, cranial neuritis, and radiculoneuritis is described. Early treatment with penicillin in children aborts the progress of the disease.

One case recently reported [2], a girl from Wisconsin who had classic untreated Lyme disease at 13 years of age, developed severe focal inflammatory encephalitis with positive serologic tests 6 years later. She presented with headaches, global aphasia, and apraxia of her right upper extremity. The EEG showed slow-wave activity over the entire left hemisphere. Treatment with penicillin G 20 mill units daily for 2 weeks was followed initially by clinical deterioration but later by gradual and steady improvement. The early diagnosis of Lyme disease is important because of the serious neurological complications that accompany delay in treatment.