Abdominal Radicular Pain From Neuroborreliosis: A Case of Bannwarth Syndrome in the Midwestern United States

A man in his mid-50s from Illinois presented with a circular rash without central clearing on his thigh. Two weeks later, he developed radicular lower abdominal and back pain. While initial imaging of the abdomen and lumbar spine was unrevealing, a physical examination later uncovered the subtle finding of dermatomal hypoesthesia. After a positive 2-tier test for Lyme disease, a diagnosis of Bannwarth syndrome was confirmed by cerebrospinal fluid, revealing lymphocytic pleocytosis and an elevated Lyme antibody index. Despite its historical association with the European Borrelia species, in the United States, Bannwarth syndrome should be considered in patients with radicular pain.