Manifestation of anaplasmosis as cerebral infarction: a case report

  • Seok Won KimChoon-Mee KimDong-Min Kim and Na Ra Yun
Contributed equally
BMC Infectious Diseases201818:409



Human granulocytic anaplasmosis is a tick-borne zoonotic disease caused by Anaplasma phagocytophilum, an obligate intracellular granulocytotropic bacterium.

Case presentation

A 70-year-old female patient was admitted with the clinical signs of fever and an altered state of consciousness 1 week after experiencing a tick bite while planting lawn grass. Magnetic resonance imaging, performed at the time of admission, indicated cerebral infarction in the left basal ganglia, whereas increasing immunofluorescence assay antibody titers for A. phagocytophilum were also documented. A. phagocytophilum was identified using groEL and ankA targeted polymerase chain reaction and sequencing. Because of severe thrombocytopenia, only doxycycline was administered, without any antiplatelet agents. Subsequently, the symptoms improved without any focal neurologic sequela.


This is the first reported case of cerebral infarction occurrence in an anaplasmosis patient.



I could literally hug these researchers who didn’t make the mistake of pronouncing this to be a “rare occurrence.”  They wisely stated it is the first reported case. 

Big difference.

Please notice the altered state of consciousness.  This stuff is surreal and unless you’ve had it, nearly unbelievable.  The basal ganglia is often affected with Lyme/MSIDS and certainly has been a marquee symptom for me personally.  Thankful this woman got prompt treatment.  Let’s pray the doxy was enough but she should be followed up on.  

Most practitioners don’t treat this seriously enough.  It can kill you.

It is a head scratcher; however, that even with severe thrombocytopenia (low platelets) and a cerebral infarction in the brain, it appears she obtained just 12 days of doxycycline.  This is a great example of an issue for further research as to treatment type and duration.  Just because “the patient exhibited an improvement in symptoms after doxycycline treatment and was discharged on the 12th day with no specific sequela,” does not mean she’s out of the woods.




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