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Ticked Off: A Case of Disappearing Cell Lines
Mahnoor Saad1, Laila Babar2, Sheza Khawaja3
1Internal Medicine, Howard University Hospital, Washington DC, USA.
Cureus
|December 18, 2024
Summary
Prompt diagnosis and doxycycline treatment of Human Granulocytic Anaplasmosis (HGA) effectively reversed severe leukopenia and thrombocytopenia in a patient. Early intervention prevents progression to potentially fatal hemophagocytic lymphohistiocytosis (HLH).
Area of Science:
- Infectious Diseases: Focuses on tick-borne rickettsial infections, specifically Human Granulocytic Anaplasmosis (HGA).
- Hematology: Addresses hematological abnormalities including leukopenia and thrombocytopenia associated with HGA.
- Public Health: Highlights the importance of recognizing HGA in endemic areas, especially among individuals with outdoor hobbies.
Background:
- Human Granulocytic Anaplasmosis (HGA) is a tick-borne illness transmitted by Ixodes scapularis, presenting with fever, low white blood cell count (leukopenia), and low platelet count (thrombocytopenia).
- Untreated HGA carries a risk of progressing to severe, potentially fatal complications like hemophagocytic lymphohistiocytosis (HLH).
- HGA shares clinical and laboratory similarities with Ehrlichiosis, necessitating prompt empirical treatment due to overlapping symptomatology.
Observation:
- A 63-year-old female gardener presented with acute fever and fatigue, exhibiting significant leukopenia (WBC 0.77 k/mcL) and thrombocytopenia (platelets 50 k/mcL).
- Initial laboratory findings also revealed elevated liver function tests (ALT 75 U/L, AST 66 U/L), with prior labs being normal.
- The patient denied tick bites or rashes but had a history of gardening, a potential exposure risk.
Findings:
- Polymerase chain reaction (PCR) testing confirmed a positive result for Anaplasma phagocytophilum antibodies, establishing the diagnosis of HGA.
- Treatment with doxycycline was initiated promptly.
- Within two days of doxycycline administration, the patient's white blood cell and platelet counts began to normalize, indicating a positive treatment response.
Implications:
- Early diagnosis and initiation of doxycycline are crucial for the successful management of HGA, preventing severe complications.
- Healthcare providers in tick-endemic regions should maintain a high index of suspicion for HGA in patients presenting with non-specific febrile illnesses and hematological abnormalities.
- Prompt treatment, even before confirmatory test results, is recommended due to the similar presentation and treatment of HGA and Ehrlichiosis.
