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Journal of General Internal Medicine

, Volume 33, Issue 4, pp 570–572 | Cite as

Smear Campaign: Misattribution of Pancytopenia to a Tick-Borne Illness

  • Jessica Lee
  • Soraya Azzawi
  • Michael J. Peluso
  • Aaron Richterman
  • Haiyan Ramirez Batlle
  • Maria A. Yialamas
Clinical Practice: Clinical Vignettes

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.

KEY WORDS

pancytopenia tick-borne illness Lyme disease acute myelogenous leukemia 

Notes

Acknowledgments

Contributors

The authors acknowledge Maureen Achabe and Elisa Aquilanti for providing the photograph of the peripheral blood smear.

Compliance with Ethical Standards

Prior Presentations

This work was presented as an oral presentation at the Society of General Internal Medicine New England Regional Meeting, Boston, MA, March 2017, and as a poster presentation at the Society of General Internal Medicine National Meeting, Washington, DC, April 2017.

Conflict of Interest

All authors declare that they have no conflict of interest.

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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Jessica Lee
    • 1
    • 2
  • Soraya Azzawi
    • 1
  • Michael J. Peluso
    • 1
    • 2
  • Aaron Richterman
    • 1
    • 2
  • Haiyan Ramirez Batlle
    • 1
    • 2
  • Maria A. Yialamas
    • 1
    • 2
    • 3
  1. 1.Harvard Medical SchoolBostonUSA
  2. 2.Department of MedicineBrigham and Women’s HospitalBostonUSA
  3. 3.Internal Medicine Residency ProgramBostonUSA

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