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Case Reports in Pediatrics
Volume 2012, Article ID 976961, 3 pages
Case Report

Diastolic Heart Murmur, Nocturnal Back Pain, and Lumbar Rigidity in a 7-Year Girl: An Unusual Manifestation of Lyme Disease in Childhood

1Department for Child and Adolescent Health, Gemeinschaftskrankenhaus, Gerhard-Kienle Weg 4, 58313 Herdecke, Germany
2Consultant for Pediatric Cardiology, Gemeinschaftskrankenhaus, Gerhard-Kienle Weg 4, 58313 Herdecke, Germany
3Center for Child and Adolescent Health, Helios Klinikum, Lutherplatz 40, 47805 Krefeld, Germany
4University of Witten/Herdecke, Faculty of Health, Center for integrative Medicine, Alfred-Herrhausenstr. 50, 58448 Witten, Germany

Received 27 June 2012; Accepted 3 September 2012

Academic Editors: N.-C. Chiu and C. R. Mart

Copyright © 2012 Genn Kameda et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A 7-year-old girl presented with nocturnal pain in her back and legs. The physical examination revealed a loud opening sound of the mitral valve and lumbar rigidity. With the exception of significantly increased anti-nuclear antibody (ANA) levels, the immunological findings did not show any other abnormal parameters, also spinal magnetic resonance imaging (MRI) and ultrasound examination of the abdomen and pelvis yield no pathological findings. The lumbar puncture showed a lymphocytic pleocytosis as well as an intrathecal synthesis of Borrelia-specific antibodies. Echocardiography showed a thickened mitral valve with mild regurgitation. No other signs of florid endocarditis or myocarditis could be detected. Due to these findings, the diagnosis Lyme neuroborreliosis was made and an intravenous antibiotic therapy was given. The clinical symptoms subsided. Six months later, she had an almost normal mitral valve with only trivial mitral insufficiency. The association between the lumbar rigidity and the thickened mitral valve remains unclear. The case of our patient with nocturnal back and leg pain may be considered a rare case of Lyme neuroborreliosis with meningoradiculitis in children, and to our knowledge these symptoms together with cardiac involvement, such as a significantly thickened mitral valve, have not yet been described in the literature.