Cerebral haemorrhage as a clinical manifestation of human ehrlichiosis

A 16-year-old young man presented to the emergency room with new-onset generalised tonic-clonic seizures. Examination showed a Glasgow score of 13 and predominantly crural left hemiparesis. Imaging demonstrated a right frontoparietal haemorrhage of non-vascular origin with perilesional oedema. Surgical drainage was carried out, but rebleeding occurred within 24 hours following surgery, and again 1 week after discharge. On reinterrogation and examination, Ehrlichia canis infection was suspected and empirical management with doxycycline was begun. Improvement was evident 72 hours after antibiotic initiation, and PCR confirmed the diagnosis; thus, doxycycline was continued for 6 months. After 2 years, seizures recurred and treatment was reinstated with good clinical response. However, seizures reappeared whenever treatment discontinuation was attempted. Lacking alternatives, doxycycline was maintained up to the third year following the initial episode. Subsequently, the patient showed complete resolution without neurological sequelae up to his last follow-up visit, 12 months following treatment cessation.

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