{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:00:23Z","timestamp":1781643623102,"version":"3.54.5"},"reference-count":7,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,3,13]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:p>A 70-year-old man presented to the emergency department with fevers, ankle edema and nausea following a presumed insect bite on his ankle 1\u2009month prior. On examination, he was febrile and had left leg pain with passive range of motion. Laboratory studies revealed anemia, thrombocytopenia, acute kidney injury and elevated aminotransaminases. Due to his recent travel to the Northeastern United States, he was suspected of having a possible tick-borne illness. Serologies were positive for <jats:italic>Borrelia burgdorferi<\/jats:italic>, <jats:italic>Anaplasma phagocytophilum<\/jats:italic> and <jats:italic>Babesia microti<\/jats:italic>, and the patient was diagnosed with Lyme disease, babesiosis and anaplasmosis. He was treated with doxycyline, atovaquone and azithromycin, leading to resolution of symptoms. While co-infection with Lyme disease is common, infection with three tickborne illnesses at one time is relatively rare.<\/jats:p>","DOI":"10.1136\/bcr-2020-241004","type":"journal-article","created":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T12:56:48Z","timestamp":1618577808000},"page":"e241004","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["One man, three tick-borne illnesses"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1262-7703","authenticated-orcid":false,"given":"Leah","family":"Grant","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Providence Health and Services Oregon and Southwest Washington, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Mohamedy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Providence Health and Services Oregon and Southwest Washington, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Loertscher","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Providence Health and Services Oregon and Southwest Washington, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,4,16]]},"reference":[{"key":"2025082711320610000_14.4.e241004.1","unstructured":"Bennett JE , Dolin R , Blaser MJ . Ticks, including tick paralysis. In: Mandell, Douglas, and Bennett\u2019s principles and practice of infectious diseases. Philadelphia, PA: Elsevier, 2020: 3266\u201379."},{"key":"2025082711320610000_14.4.e241004.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.23.2617"},{"key":"2025082711320610000_14.4.e241004.3","unstructured":"Hu L . Clinical Manifestations of Lyme disease in adults.. In: Mitty J , ed. UpToDate. Waltham, MA: UpToDate, 2019."},{"key":"2025082711320610000_14.4.e241004.4","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciaa1215","article-title":"Clinical practice guidelines by the infectious diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of rheumatology (ACR): 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease","volume":"72","author":"Lantos","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2025082711320610000_14.4.e241004.5","doi-asserted-by":"publisher","DOI":"10.1086\/508667"},{"key":"2025082711320610000_14.4.e241004.6","unstructured":"Krause PJ . Babesiosis: clinical manifestations and diagnosis. In: Baron E , ed. UpToDate. Waltham, MA: UpToDate, 2019."},{"key":"2025082711320610000_14.4.e241004.7","doi-asserted-by":"publisher","DOI":"10.1086\/339813"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-241004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:32:12Z","timestamp":1756319532000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-241004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":7,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,16]]},"published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1136\/bcr-2020-241004"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-241004","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}