An Unusual Case of Transient Psychosis from Ehrlichia Infection

The incidence of Ehrlichia infection has been increasing since it was first discovered in 1986. Ehrlichia is transmitted by ticks and is endemic to many areas of the United States. Patients with symptoms of Ehrlichia may present to their primary care provider or an emergency department. The authors describe the case of a 50-year-old woman who was initially diagnosed with transient ischemic attack in the emergency department after experiencing facial and unilateral extremity weakness. Imaging studies were persistently negative for brain abnormality. She followed up with her primary physician with persistent symptoms, which began to include hallucinations. She was diagnosed with Ehrlichia infection through laboratory studies. This patient was treated with doxycycline therapy for three weeks and has not had a recurrence of symptoms. The diagnosis of ehrlichiosis needs to be considered in the differential for patients with neurologic and/or psychiatric symptoms, especially in areas of the country where tick-borne illnesses are endemic.