Do Not Forget About the Ticks: An Unusual Cause of Fever, GI Distress, and Cytopenias in a Child With ALL

Area of Science:

• Pediatric Hematology Oncology
• Infectious Diseases
• Tick-Borne Illnesses

Background:

• Children undergoing chemotherapy for acute lymphoblastic leukemia are immunocompromised.
• Maintenance chemotherapy can increase susceptibility to infections.
• Tick-borne diseases pose a risk, especially in endemic areas.

Observation:

• A 5-year-old male with B-cell acute lymphoblastic leukemia in remission presented with fever, emesis, diarrhea, headache, and lethargy.
• The patient developed rapidly progressive cytopenias.
• Co-infection with acute human granulocytic anaplasmosis and past Babesia microti infection was diagnosed.

Findings:

• Concurrent infections with Anaplasma phagocytophilum and Babesia microti can occur in immunocompromised children.
• Rapidly progressive cytopenias can be a sign of severe tick-borne illness in this population.
• Diagnosis requires a high index of suspicion and appropriate diagnostic testing.

Implications:

• Clinicians should consider tick-borne diseases in the differential diagnosis of febrile illnesses in children on immunosuppressive therapy.
• Broadening the differential diagnosis is crucial for timely and accurate diagnosis.
• Awareness of potential tick exposure is vital for managing infections in pediatric oncology patients.