Tick-borne relapsing fever manifesting with acute respiratory distress syndrome and multi-organ failure in a pediatric patient: a case report

Background Tick-borne relapsing fever is characterized by recurrent spirochetemia, with clinical presentations ranging from mild illness to multi-organ failure. Treatment of tick-borne relapsing fever can trigger the Jarisch–Herxheimer reaction, a transient worsening of symptoms shortly after initiating antibiotics. Case presentation We report a case of an 11-year-old American female patient, ethnicity unknown, with a severe presentation of tick-borne relapsing fever and Jarisch–Herxheimer reaction. The patient developed severe multi-organ failure requiring intubation, mechanical ventilation, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), plasmapheresis for presumed thrombocytopenia-associated multiple organ failure, and continuous renal replacement therapy. (CRRT). The patient showed rapid improvement with normalization of end-organ function, allowing for decannulation from VA-ECMO, extubation, and discontinuation of CRRT within 5 days. She was discharged home to complete a 14-day course of doxycycline. Conclusions This case underscores the importance of early recognition and treatment of tick-borne relapsing fever and Jarisch–Herxheimer reaction, as well as the extensive multidisciplinary care required to optimize outcomes for critically ill pediatric patients.