Powassan virus encephalitis, severe babesiosis and lyme carditis in a single patient. Issue 11 (10th November 2019)

• Record Type: Journal Article
• Authors: Khan, Abdul Moiz; Shahzad, Sheikh Raza; Ashraf, Muhammad Farhan; Naseer, Usman
• Is Part Of: BMJ case reports. Volume 12:Issue 11(2019)
• Publication Date: 2019-11-10
• Subjects: infectious diseases -- infection (neurology) -- haematology (incl blood transfusion) -- arrhythmias -- intensive care; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2019-231645
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Ixodes scapularis is responsible for transmission of Borrelia burgdorferi, B. miyamotoi, Babesia microti, Anaplasma phagocytophilum and Powassan virus to humans. We present a case of an 87-year-old man who presented with fever and altered mental status. Initial workup revealed haemolytic anaemia, thrombocytopenia, mild hepatitis and acute kidney injury. Patient tested positive for B. burgdorferi and Babesia microti, and was started on doxycycline, atovaquone and azithromycin. He also underwent exchange transfusion twice. After some initial improvement, patient had acute deterioration of mental status and appearance of neurological findings like myoclonus and tremors. Therefore, testing for arboviruses was done and results were positive for Powassan virus. During a protracted course of hospitalisation, patient required intubation for respiratory failure and temporary pacemaker for unstable arrythmias from Lyme carditis. Patient developed permanent neurological deficits even after recovery from the acute illness.