A case of concurrent Lyme meningitis with ehrlichiosis

We report an a case of concurrent Lyme meningitis and ehrlichiosis in a patient with occupational exposure to ticks as a logger. The patient had a febrile illness with a reticulate erythematous rash on his upper torso, meningoencephalitis, thrombocytopenia, and hepatiis. Acute and convalescent serologies were consistent with a dual infection with Lyme disease and ehrlichiosis. Ixodes scapularis is the tick that is associated with Lyme disease in our area and this tick has also been reported to harbor the species of Ehrlichia that causes human granulocytic ehrlichiosis. Empiric therapy for both Lyme disease and ehrlichiosis should be considered in any patient suspected of having a tick-borne illness and presenting with signs and symptoms compatible with both infections.