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- Title
Smear Campaign: Misattribution of Pancytopenia to a Tick-Borne Illness.
- Authors
Azzawi, Soraya; Lee, Jessica; Peluso, Michael J.; Richterman, Aaron; Batlle, Haiyan Ramirez; Yialamas, Maria A.
- 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.
- Subjects
PANCYTOPENIA; TICK-borne diseases; LYME disease; MYELOID leukemia; LEUCOCYTES; THERAPEUTICS
- Publication
JGIM: Journal of General Internal Medicine, 2018, Vol 33, Issue 4, p570
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-017-4241-5