Title |
Smear Campaign: Misattribution of Pancytopenia to a Tick-Borne Illness
|
---|---|
Published in |
Journal of General Internal Medicine, December 2017
|
DOI | 10.1007/s11606-017-4241-5 |
Pubmed ID | |
Authors |
Jessica Lee, Soraya Azzawi, Michael J. Peluso, Aaron Richterman, Haiyan Ramirez Batlle, Maria A. Yialamas |
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. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 1 | 33% |
Unknown | 2 | 67% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 2 | 67% |
Science communicators (journalists, bloggers, editors) | 1 | 33% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 10 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 2 | 20% |
Student > Master | 1 | 10% |
Student > Doctoral Student | 1 | 10% |
Other | 1 | 10% |
Student > Ph. D. Student | 1 | 10% |
Other | 1 | 10% |
Unknown | 3 | 30% |
Readers by discipline | Count | As % |
---|---|---|
Immunology and Microbiology | 2 | 20% |
Medicine and Dentistry | 2 | 20% |
Social Sciences | 1 | 10% |
Biochemistry, Genetics and Molecular Biology | 1 | 10% |
Unknown | 4 | 40% |