Human granulocytic anaplasmosis acquired in Switzerland: a case report.
Alan Costa, Reto Lienhard, Florian Tagini et al.
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Case in brief
A man in his early seventies taking methotrexate for ankylosing spondylitis and with tick exposure developed fever, headache and dizziness, followed by somnolence, dysarthria, ataxia and diplopia. Cerebrospinal fluid showed mild mononuclear pleocytosis and elevated protein; brain MRI showed nonspecific leukoencephalopathy. Fever persisted despite empirical beta-lactam and macrolide treatment. Intravenous doxycycline was started empirically, and he recovered clinically within 3 days. Human granulocytic anaplasmosis was confirmed retrospectively by IgG seroconversion, with an 8-fold titre increase from <1:64 to 1:512 after 6 weeks.
What made this case unusual
The case documents tick-acquired human granulocytic anaplasmosis in Switzerland, presenting with neurological deterioration and nonspecific MRI findings; confirmation came retrospectively rather than during the acute illness.
Diagnostic / clinical pearl
In a patient with tick exposure and severe acute febrile illness without an alternative diagnosis, consider anaplasmosis; acute-phase diagnosis relies on blood PCR, while seroconversion can confirm infection later.
Why it matters
This case illustrates that human granulocytic anaplasmosis can be acquired in Switzerland and may be overlooked where it is not considered endemic.