A Tick-borne Relapsing Fever Treated with Empiric Doxycycline

CaseA 32-year-old male with no significant medical history presented to his primary care physician for a return to work note after a week-long illness with fevers (Tmax of 103), chills and rigors, headaches, nausea, vomiting and night sweats.His symptoms had largely resolved but did report bilateral leg cramps with exertion.His husband had similar symptoms.A few days before symptoms onset a week ago he completed a 3000 ft elevation mountain climb in Las Vegas, NV.His exam was unremarkable and an extensive panel of labs were ordered.His coccidioides IgG/IgM antibodies were negative along with negative creatine kinase (CK), Epstein-Barr virus (EBV) IgM/ IgG and cytomegalovirus (CMV) IgM/IgG.His inflammatory markers Ferritin, Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) were elevated with a normal leukocyte count.Monocytes and granulocytes were elevated on his differentials.Other positive labs included Chlamydia Pneumoniae IgG with negative Chlamydia Pneumoniae IgM.His symptoms were mild enough that the patient was comfortable traveling to New Jersey.