Abstract
Human granulocytic anaplasmosis (HGA) is a tick-borne infection caused by a small intracellular gram-negative bacteria called Anaplasma phagocytophilum. It is a multisystemic disease, but neurological manifestations are rare. We report a rare neurological manifestation of stroke in a 65-year-old woman who presented initially with abdominal pain, nausea, vomiting, and dizziness. She developed worsening renal function and encephalopathy requiring hemodialysis and intubation for airway protection. Brain imaging showed acute infarcts. Morulae were seen on the peripheral smear. The diagnosis was confirmed with a positive Anaplasma PCR. Her mentation improved after 48 hours on doxycycline.