Anaplasmosis and Trigeminal Neuralgia: A Rare Neurologic Case
Anaplasmosis may rarely present with neurologic symptoms
Severe facial pain can mimic trigeminal neuralgia
Tick-borne infections should be considered in endemic areas
Anaplasmosis is a tick-borne infection that commonly presents with fever, headache, myalgia, leukopenia, thrombocytopenia, and elevated liver enzymes. Although neurologic complications are uncommon, rare cases involving the nervous system have been reported.
According to the authors, the woman experienced a “sudden onset of severe, lancinating headache in the distribution of the fifth cranial nerve bilaterally.”1 She had been treated for Lyme disease two months earlier following a tick bite and a rash on her torso. She had since been bitten by a non-engorged tick.
Her neurologic examination was felt to be consistent with trigeminal neuralgia. Trigeminal neuralgia is a chronic pain disorder involving the trigeminal nerve and may cause sudden shock-like or stabbing facial pain, typically affecting one side of the face.2
The patient’s mother had a history of trigeminal neuralgia. The physicians did not find evidence supporting active Lyme disease.
“However, anaplasmosis and ehrlichiosis can both develop over a shorter timeframe and without a noticeable rash, making these infections a more likely explanation of the patient’s signs and symptoms,” wrote the authors.
To confirm the suspected diagnosis, a tick-borne disease panel was ordered and was positive for Anaplasma phagocytophilum DNA by PCR.
“Although severe headache is a common presenting symptom in patients with anaplasmosis, prior studies have not linked anaplasmosis and trigeminal neuralgia,” the authors explained.
Neurologic Symptoms in Anaplasmosis
Rare neurologic manifestations associated with anaplasmosis have included demyelinating polyneuropathy, brachial plexopathy, encephalopathy, and other inflammatory neurologic complications.
The authors concluded, “Our case suggests that anaplasmosis was the cause of our patient’s new-onset trigeminal neuralgia.”
The woman was treated with a 3-week course of doxycycline for anaplasmosis and was prescribed gabapentin for trigeminal neuralgia.
She experienced marked improvement in her headaches. Her leukopenia, thrombocytopenia, and abnormal hepatic enzymes returned to normal.
The authors reviewed the broader literature on anaplasmosis, emphasizing that symptoms are often nonspecific and may include fever, myalgia, headache, leukopenia, thrombocytopenia, elevated transaminases, and elevated lactate dehydrogenase.
Because neurologic symptoms can overlap with Lyme disease and other tick-borne illnesses, clinicians in endemic regions may need to consider multiple infections when evaluating unexplained neurologic complaints after tick exposure.
Frequently Asked Questions
Can anaplasmosis cause neurologic symptoms?
Yes. Although uncommon, anaplasmosis has been associated with neurologic complications including encephalopathy, neuropathy, brachial plexopathy, and rare cranial nerve symptoms.
What is trigeminal neuralgia?
Trigeminal neuralgia is a chronic pain condition involving the trigeminal nerve that may cause sudden stabbing, burning, or electric shock-like facial pain.
Can Lyme disease cause trigeminal neuralgia?
Neurologic Lyme disease has been associated with cranial neuropathies and facial pain syndromes, although other tick-borne infections may also contribute to neurologic symptoms.
How is anaplasmosis diagnosed?
Anaplasmosis may be diagnosed using PCR testing, blood smear findings, serologic testing, and clinical features such as fever, headache, leukopenia, thrombocytopenia, and elevated liver enzymes.
Did the patient improve with treatment?
Yes. The patient improved following doxycycline treatment for anaplasmosis along with symptomatic treatment for trigeminal neuralgia.
Clinical Takeaway
Anaplasmosis may rarely present with neurologic symptoms involving cranial nerves or severe facial pain syndromes. This case highlights the importance of considering tick-borne infections such as anaplasmosis, ehrlichiosis, and Lyme disease in patients presenting with unexplained neurologic symptoms in endemic areas.
Careful evaluation of tick-borne infections may help identify treatable causes of rare neurologic presentations.
Related Articles
These related articles explore neurologic complications of tick-borne infections, cognitive symptoms, and overlapping manifestations involving Lyme disease and anaplasmosis.
Anaplasmosis in the Brain
Anaplasmosis and Babesia Infection Causing Cognitive Impairment
Neurologic Lyme Disease
Lyme Disease Symptoms Guide
Delayed Lyme Disease Diagnosis
References
- LeDonne MJ, Ahmed SA, Keeney SM, Nadworny H. Trigeminal Neuralgia as the Principal Manifestation of Anaplasmosis: A Case Report. Cureus. 2022;14(1):e21668.
- Trigeminal neuralgia. MedlinePlus.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
With the inaccuracies of so many “lyme” tests, it might be even better if clinicians would offer a trial of antibiotics for at least 3 weeks to see if there is improvement rather than rely on lab results.
Moreover, 7th nerve palsy from Lyme disease occurs quite early in the infection before the the tests are positive.
After getting Anaplasmosis I have Neuropathy in feet and legs. I also had Babesia from another tick bite. No Trigeminal Neuralgia to date.
Thanks for sharing.
I don’t believe this is all that rare.
I know several this past year that had these symptoms.
One was given minocycline finally after the 3rd bout that left them also semidisabled. It started with this extreme headache but on the outside of the brain as she described it.
The minocycline cleared the symptoms.
Great
I was back in the 80s and pin down with a fever for four days of 103 to 104. The doctor because they didn’t know how to treat it gave me six days amoxicillin 30 days later it returned. Now that I’m in my 60s I am in system isn’t what it used to be and the disease has jumped the brain barrier. I believe it’s traveling to my nervous system and Causing me to have peripheral neuropathy. I pray that one day they have a cure for this dreadful disease.
I advise my patients to try another antibiotic if amoxicillin fails. Amoxicillin is not effective for some patients. And then there is always the possibility of reinfection with a new tick borne illness.