Smear Campaign: Misattribution of Pancytopenia to a Tick-Borne Illness

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From: Journal of General Internal Medicine(Vol. 33, Issue 4)
Publisher: Springer
Document Type: Report
Length: 215 words

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Abstract :

To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s11606-017-4241-5 Byline: Jessica Lee (1,2), Soraya Azzawi (1), Michael J. Peluso (1,2), Aaron Richterman (1,2), Haiyan Ramirez Batlle (1,2), Maria A. Yialamas (1,2,3) Keywords: pancytopenia; tick-borne illness; Lyme disease; acute myelogenous leukemia Abstract: We report the case of a 51-year-old woman presenting with a targetoid rash and pancytopenia after a tick bite. Initial evaluation was notable for severe neutropenia on the complete blood cell count differential, a positive Lyme IgM antibody, and a peripheral blood smear demonstrating atypical lymphocytes. While her pancytopenia was initially attributed to tick-borne illness, peripheral flow cytometry showed 7% myeloblasts, and a bone marrow biopsy confirmed 60% blasts. The patient was ultimately diagnosed with acute myelogenous leukemia, in addition to early, localized Lyme disease. This case highlights the differential diagnosis for pancytopenia, cytopenia patterns for different tick-borne illnesses, the risk of premature closure in internal medicine, and management of Lyme disease in hosts with altered immunity. Author Affiliation: (1) 000000041936754X, grid.38142.3c, Harvard Medical School, Boston, MA, USA (2) 0000 0004 0378 8294, grid.62560.37, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA (3) Internal Medicine Residency Program, Boston, MA, USA Article History: Registration Date: 17/11/2017 Received Date: 30/06/2017 Accepted Date: 17/11/2017 Online Date: 22/12/2017

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Gale Document Number: GALE|A533105858