SHM Converge Scientific Abstract ePoster Gallery-Ticked Off: A Case of Relapsing Fever

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A 67-year-old woman with mitral valve prolapse was admitted for hypoxic respiratory failure after a 2-week illness marked by recurrent fever, malaise, weakness, nausea, and vomiting. Initial outpatient testing showed pancytopenia and elevated inflammatory markers, which improved temporarily before symptoms recurred. On admission, she developed recurrent cytopenias, elevated CRP/ESR, new liver enzyme abnormalities, elevated lactate, pleural effusions, and mesenteric/periaortic lymphadenopathy. <br /><br />Her recent history was notable for travel to Lake Tahoe in eastern California about 3 weeks before symptom onset, where she noticed insect bites but no rash. She had also started terbinafine 2 weeks before symptoms, but had no other medication changes. A peripheral blood smear revealed circulating spirochetes morphologically consistent with Borrelia species. She was started on ceftriaxone with clinical improvement and was discharged to complete a 14-day course of doxycycline.<br /><br />Further testing clarified the diagnosis: a standard Borrelia species PCR for B. burgdorferi was negative, while a Relapsing Fever PCR panel was positive, confirming tick-borne relapsing fever (TBRF). <br /><br />The case highlights that TBRF can present with cyclical episodes of fever and malaise separated by well periods, typically beginning 1–3 weeks after exposure. It may also cause a systemic inflammatory presentation with hospitalization required in a substantial proportion of cases. Diagnosis requires appropriate testing for relapsing fever Borrelia species, not just Lyme-focused Borrelia burgdorferi PCR.

Asset Subtitle

Ashish Gandhi

Meta Tag

Author List Ashish Gandhi, Qi Quan Leong, Shubhra Gupta, Xiangdong Xu

Category Clinical Vignettes

Concept Tick-Borne Relapsing Fever

Concept Recurrent Fever

Concept Borrelia

Concept Pancytopenia

Concept Borrelia burgdorferi

Distinguished Non-Finalist

Presenter Organization University of California, San Francisco

Presenting Author Ashish Gandhi

Track Adult

Keywords

tick-borne relapsing fever

Borrelia

spirochetes

recurrent fever

cytopenia

mitral valve prolapse

Lake Tahoe exposure

ceftriaxone

doxycycline

PCR diagnosis

Tick-Borne Relapsing Fever

Recurrent Fever

Borrelia

Pancytopenia

Borrelia burgdorferi