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Heartland virus (HRTV), first described in 2009 in Missouri and transmitted by the Amblyomma americanum (lone star) tick, is highly prevalent in the midwestern and southern U.S. Severe disease typically occurs in men older than 50 with comorbidities. Infection, which usually begins as a nonspecific febrile illness accompanied by leuco- and thrombocytopenia, is often self-limited — but deaths have occurred in association with hemophagocytic lymphohistiocytosis (HLH).
This case report involves a male in his late 60s with a history of splenectomy, who lived in Maryland and Virginia and had not traveled to any region known to be endemic for HRTV infection. He presented with diarrhea, dyspnea, myalgia, and malaise; laboratory findings included hy…