Human granulocytic ehrlichiosis presenting as facial diplegia in a 42-year-old woman

Neurologic manifestations of human ehrlichiosis are unusual and have been d escribed almost exclusively in human monocytic ehrlichiosis associated with Ehrlichia chaffeensis. We report here a case of a previously healthy 42-ye ar-old woman who developed bilateral facial nerve palsies in association wi th infection by the agent of human granulocytic ehrlichiosis (aoHGE). The d iagnosis was made by specific polymerase chain reaction amplification of ao HGE sequences from samples of the patient's blood and cerebrospinal fluid ( CSF), as well as propagation of aoHGE in culture of HL60 cells inoculated w ith the patient's CSF To our knowledge, this is the first report directly d emonstrating the presence of aoHGE in CSF, and it underscores the importanc e of considering HGE in patients presenting with a nonspecific febrile illn ess and unexplained neurologic manifestations. HGE should also be considere d in the differential diagnosis of bilateral facial palsy-a rare occurrence .