{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:50:56Z","timestamp":1792525856700,"version":"4.5.0"},"reference-count":9,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,11,7]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>A 64-year-old woman presented with 24 hours of lethargy, confusion, headache, nausea and vomiting. Examination revealed expressive aphasia, conjunctival suffusion and a tick embedded in her popliteal fossa. Labs revealed hyponatraemia, transaminitis, leucopenia, thrombocytopenia and an elevated C reactive protein. Peripheral blood smear was unremarkable. MRI\/magnetic resonance angiogram revealed bilateral frontoparietal subarachnoid haemorrhage which was further confirmed by lumbar puncture which revealed six nucleated cells, 92% lymphocytes, 1460 red blood cells, normal glucose and protein and negative cryptococcal antigen, herpes simplex PCR and Lyme PCR. Serum Lyme IgG\/IgM antibodies and PCR, <jats:italic>Erlichia chaffeensis<\/jats:italic> serum IgG\/IgM antibodies and PCR and anaplasma serum IgG\/IgM antibodies were negative. Anaplasmosis serum PCR was positive. The tick was identified as <jats:italic>Ixodes scapularis<\/jats:italic>. The patient was diagnosed with anaplasmosis and treated with 21 days of doxycycline resulting in improvement of symptoms, but lingering headaches and word finding difficulties.<\/jats:p>","DOI":"10.1136\/bcr-2021-243665","type":"journal-article","created":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T11:50:33Z","timestamp":1638964233000},"page":"e243665","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Central nervous system involvement of anaplasmosi<b>s<\/b>"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2756-8099","authenticated-orcid":false,"given":"Jon Brandon","family":"Mullholand","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathanial","family":"Tolman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"De Obaldia","sequence":"additional","affiliation":[{"name":"Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Hennrikus","sequence":"additional","affiliation":[{"name":"Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,12,8]]},"reference":[{"key":"2025082712514332000_14.12.e243665.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h568"},{"key":"2025082712514332000_14.12.e243665.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.2884"},{"key":"2025082712514332000_14.12.e243665.3","doi-asserted-by":"crossref","first-page":"e00083","DOI":"10.1128\/CMR.00083-18","article-title":"Emerging tick-borne diseases","volume":"33","author":"Madison-Antenucci","year":"2020","journal-title":"Clin Microbiol Rev"},{"key":"2025082712514332000_14.12.e243665.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.cll.2017.01.006"},{"key":"2025082712514332000_14.12.e243665.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2015.02.007"},{"key":"2025082712514332000_14.12.e243665.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.2884"},{"key":"2025082712514332000_14.12.e243665.7","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A1579"},{"key":"2025082712514332000_14.12.e243665.8","doi-asserted-by":"publisher","DOI":"10.1177\/1941874415596743"},{"key":"2025082712514332000_14.12.e243665.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2011.09.008"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-243665","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:51:46Z","timestamp":1756324306000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-243665"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":9,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,8]]},"published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1136\/bcr-2021-243665"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-243665","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]}}}