Notable Cases by Dr. Habib Moshref Razavi:
A 54-year-old male with a history of cardiovascular disease presented with intermittent fevers, chills, and dizziness. Two weeks prior, he had been gardening in Pemberton, BC, where he developed a red, pruritic rash on his arms following multiple bug bites. Although he did not observe a tick or erythema migrans, the rash resolved within days. His initial symptoms were attributed to heat exposure, but he soon experienced recurrent fevers, night sweats, dry cough, and cervical lymphadenopathy. These symptoms temporarily improved with over-the-counter medications but later worsened, leading to near-syncope and chest pain.
Upon presentation, his physical exam was largely unremarkable aside from small petechiae on his right leg and a subcutaneous nodule on his forearm. Blood film examination revealed numerous spirochetes, raising suspicion for a tick-borne illness. Serological testing for Lyme disease (Borrelia burgdorferi) and Borrelia hermsii (responsible for tick-borne relapsing fever) was initiated, given the patient’s exposure history and clinical presentation.
This case highlights the importance of considering tick-borne illnesses in patients with recent outdoor exposure and nonspecific symptoms. A 14-day course of doxycycline was recommended to cover both Borrelia species, with follow-up testing pending to confirm the diagnosis.
Key takeaway: Be vigilant for vector-borne infections, even in regions where Lyme disease is not endemic. (May-Grünwald Giemsa stain x100 magnification). hematology#, hematopathology#, pathology#, parasites#, tickborne illness#, morphology#.
