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Simultaneous Detection of Different Antibody Classes in a Multiplexed Serological Test

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Published on: July 14, 2023

Seronegative Lyme arthritis.

A Holl-Wieden¹, S Suerbaum, H J Girschick

¹Children's hospital, Section of Pediatric Rheumatology, Immunology and Infectious diseases, University of Wuerzburg, Josef-Schneider-Str. 2, 97090 Wuerzburg, Germany.

Rheumatology International

|April 5, 2007

Summary

Juvenile idiopathic arthritis can mimic Lyme arthritis. Borrelia burgdorferi DNA in joint fluid confirmed Lyme arthritis in a child, even without detectable antibodies, highlighting diagnostic challenges.

Area of Science:

Pediatric Rheumatology
Infectious Diseases
Molecular Diagnostics

Background:

Juvenile idiopathic arthritis (JIA) is a common rheumatic disease in children.
Lyme arthritis, caused by Borrelia burgdorferi, is a significant differential diagnosis in pediatric arthritis.
Seronegative presentations of infectious arthritis pose diagnostic challenges.

Observation:

A 10-year-old girl with a history of JIA presented with a new knee arthritis flare after a 3-year medication break.
Standard serological tests for Borrelia burgdorferi infection were negative.
Detection of Borrelia burgdorferi DNA in synovial fluid was crucial for diagnosis.

Findings:

The patient was diagnosed with Lyme arthritis based on direct detection of pathogen DNA.

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No humoral immune response to Borrelia burgdorferi was observed at diagnosis or during a 3-year follow-up.

This case highlights a seronegative Lyme arthritis presentation in a pediatric patient.

Implications:

Molecular detection of Borrelia burgdorferi DNA is essential for diagnosing Lyme arthritis, especially in seronegative cases.
Clinicians should consider Lyme arthritis in children with joint effusions, even with a history of JIA and negative serology.
This case underscores the importance of considering infectious etiologies in pediatric arthritis flares.