Lyme disease is a multisystem infectious disease. It is caused by dissemination of Borrelia spirochetes after a tick bite. It has various  manifestations across different age groups. Commonly involved organs are skin, joints and the nervous system. Nervous system Lyme disease has wide spectrum of manifestations. While facial nerve palsy and subacute meningitis are commonly observed in the pediatric population, our case report reveals an uncommon manifestation of the nervous system Lyme disease . A 4-year-old patient exhibited mood changes, behavioral issues, and generalized tonic-clonic seizures. Extensive diagnostic workup initially yielded no clear cause until positive IgM and IgG serology for Borrelia suggested Lyme neuroborreliosis . This differs from the usual symptoms seen in pediatric cases . The patient responded positively to antibiotic treatment, but persistent behavioral issues post-treatment raise questions about potential long-term effects.  This case underscores the importance of considering Lyme disease in atypical presentations, even in non-endemic areas, necessitating an adaptable diagnostic approach for improved outcomes, especially in pediatric patients. Continued research into the comprehensive understanding of Lyme disease in pediatric patients is crucial.

Ia Khurtsilava, from Tbilisi Medical Academy, Georgia.