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One man, three tick-borne illnesses
  1. Leah Grant,
  2. Imran Mohamedy and
  3. Laura Loertscher
  1. Department of Internal Medicine, Providence Health and Services Oregon and Southwest Washington, Portland, Oregon, USA
  1. Correspondence to Dr Leah Grant; leahmgrant1{at}


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 month 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 Borrelia burgdorferi, Anaplasma phagocytophilum and Babesia microti, 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.

  • infectious diseases
  • medical management
  • drugs: infectious diseases
  • disease and health outcomes

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  • Contributors Drafting the article: LG and IM. Critical revision of the article: LG, IM and LL. Final approval of the version to be published: LG, IM and LL.

  • 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.

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