Tickborne Disease in a 53-year-old WomanTicks and Tick-borne Disease Clinical Pearls of Wisdom Q&A Case
Tickborne diseases in the United States include Rocky Mountain spotted fever, Lyme disease, ehrlichiosis, tularemia, babesiosis, Colorado tick fever, and many others according to the CDC. It is important for physicians to consider these illnesses when patients present with influenza-like symptoms.
Early, accurate diagnosis allows treatment that may help prevent significant morbidity and possible mortality. Because 24 to 48 hours of attachment to the host are required for infection to occur, early removal can help prevent disease.
A 53-year-old woman presents, in August, with complaints of fever, myalgias, headache, fatigue and cough. She does not have ill household contacts. She recently travelled from Massachusetts, where she lives, to visit family in North Carolina. She returned a week ago. She does remember having been bitten frequently by mosquitos while hiking in the mountains of North Carolina.
On physical examination, she is pale, with clear breath sounds and a regular cardiac exam. Abdominal examination is notable for mildly tender splenomegaly. No erythema migrans lesions are noted on skin examination.
A chest x-ray is negative. Laboratories reveal a low hemoglobin of 8.0 g/dL (normal 12.0-16.0 g/dL). Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are both elevated, at 70 U/L and 80 U/L, respectively (normal for both 8-20 U/L).
Bilirubin, lactate dehydrogenase (LDH) and haptoglobin are all elevated, as well.
A rapid PCR for influenza is negative for both influenza A and influenza B.
Dipstick urinalysis reveals elevated bilirubin with negative leukocyte esterase and negative nitrite.
A peripheral blood smear is significant for the presence of schistocytes, as well as maroon red blood cell inclusions that form rings in the shape of a Maltese cross.
Of the following illnesses, which is most likely in this patient, given the presentation and laboratory findings?
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