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Case report
Powassan virus encephalitis, severe babesiosis and lyme carditis in a single patient
  1. Abdul Moiz Khan,
  2. Sheikh Raza Shahzad,
  3. Muhammad Farhan Ashraf and
  4. Usman Naseer
  1. Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA
  1. Correspondence to Dr Abdul Moiz Khan; khana13{at}


Ixodes scapularis is responsible for transmission of Borrelia burgdorferi, B. miyamotoi, Babesia microti, Anaplasma phagocytophilum and Powassan virus to humans. We present a case of an 87-year-old man who presented with fever and altered mental status. Initial workup revealed haemolytic anaemia, thrombocytopenia, mild hepatitis and acute kidney injury. Patient tested positive for B. burgdorferi and Babesia microti, and was started on doxycycline, atovaquone and azithromycin. He also underwent exchange transfusion twice. After some initial improvement, patient had acute deterioration of mental status and appearance of neurological findings like myoclonus and tremors. Therefore, testing for arboviruses was done and results were positive for Powassan virus. During a protracted course of hospitalisation, patient required intubation for respiratory failure and temporary pacemaker for unstable arrythmias from Lyme carditis. Patient developed permanent neurological deficits even after recovery from the acute illness.

  • infectious diseases
  • infection (neurology)
  • haematology (incl blood transfusion)
  • arrhythmias
  • intensive care
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  • Contributors AMK, served as the primary author of this case report and worked on all the elements right from the introduction to the discussions. SRS was designated with the task of working on the case presentation as well as to find the relevant resources for the discussions. MFA worked on the discussion section with special reference to finding literature on the rare Powassan virus. UN also worked on case presentation and made sure the chronology of how the case progressed during the course of hospitalisation was accurate. All authors of this case report had important contributions that led to its final form.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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