Anaplasmosis and Trigeminal Neuralgia: A Rare Neurologic Case

Anaplasmosis can affect the nervous system
Severe facial pain may not be typical
But rare presentations do occur

Anaplasmosis trigeminal neuralgia is an uncommon but important clinical presentation. This case highlights how tick-borne infections can produce neurologic symptoms—similar to patterns seen in anaplasmosis affecting the brain—that may initially be attributed to other conditions.

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.

Trigeminal Neuralgia Presentation

Her neurologic exam was felt to be consistent with a diagnosis of trigeminal neuralgia.

Trigeminal neuralgia (TN) is a type of chronic pain that affects your face. It causes extreme, sudden burning or shock-like pain and usually affects one side of the face.²

The patient’s mother had a history of trigeminal neuralgia, raising the possibility of a hereditary predisposition.

However, clinicians did not find evidence of active Lyme disease.

Diagnosis: Anaplasmosis Identified

“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.

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.

“Our case suggests that anaplasmosis was the cause of our patient’s new-onset trigeminal neuralgia.”

Treatment and Outcome

The woman was treated with a 3-week course of doxycycline for anaplasmosis and was prescribed gabapentin 300 mg for her trigeminal neuralgia.

She had marked improvement in her headaches.

Her leukopenia, thrombocytopenia, and abnormal hepatic enzymes returned to normal.

Clinical Features of Anaplasmosis

The authors reviewed the literature on anaplasmosis, noting that symptoms are often non-specific and may include:

• Fever
• Myalgia
• Headache
• No rash in many cases

Laboratory findings may include:

• Leukopenia
• Thrombocytopenia
• Elevated transaminases
• Elevated lactate dehydrogenase

“Rare cases of anaplasmosis showcase post-infectious complications such as demyelinating polyneuropathy and brachial plexopathy,” wrote the authors.

“However, this patient’s presentation of anaplasmosis with new onset trigeminal neuralgia appears to be unique and rare.”

Clinical Perspective

This case highlights how tick-borne infections can present with unexpected neurologic symptoms.

Anaplasmosis trigeminal neuralgia may be rare—but it underscores the importance of considering tick-borne infections in patients with unexplained neurologic pain.

The authors urge clinicians to consider Lyme disease, anaplasmosis, and ehrlichiosis in “a patient presenting to the hospital with non-specific symptoms of fever, myalgia, and headache in tick endemic areas”—especially in patients with possible tick-borne co-infections.

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