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.
CITATION STYLE
Lee, J., Azzawi, S., Peluso, M. J., Richterman, A., Batlle, H. R., & Yialamas, M. A. (2018). Smear Campaign: Misattribution of Pancytopenia to a Tick-Borne Illness. Journal of General Internal Medicine, 33(4), 570–572. https://doi.org/10.1007/s11606-017-4241-5
Mendeley helps you to discover research relevant for your work.