title: Ehrlichiosis infection in a 5-year-old boy with neutropenia, anemia, thrombocytopenia, and hepatosplenomegaly.
abstract: Ehrlichiosis should be considered in the differential diagnosis of any patient with recent fever, pancytopenia, hepatosplenomegaly, and history of tick exposure. We present a previously healthy 5-year-old boy who was referred to the Hematology-Oncology Clinic to consider a bone marrow etiologic process after his pediatrician discovered progressive neutropenia, anemia, thrombocytopenia, and hepatosplenomegaly accompanied by 2 days of fever. Bone marrow aspirate and biopsy were nonrevealing. Because of the history of a recent tick bite, a diagnosis of ehrlichiosis infection was considered and ultimately confirmed by IgG-specific serum testing. The patient's fever was treated symptomatically with acetaminophen, and symptoms resolved on their own without intervention. Ehrlichiosis is a tick-borne infection that occurs throughout the spring and summer, often causing findings that mimic a malignancy or serious hematologic disorder. The diagnosis should be considered in any person living in tick-infested areas and can be confirmed by polymerase chain reaction or serum antibody titers. Treatment with doxycycline can lead to rapid clinical improvement if the diagnosis is made early.
authors.affiliation: Division of Pediatric Hematology-Oncology, Hasbro Children's Hospital of Rhode Island Hospital, Providence 02903, USA.
authors.forename: J
authors.initials: J
authors.lastname: Schiffman
authors.forename: M
authors.initials: M
authors.lastname: Haq
authors.forename: F
authors.initials: F
authors.lastname: Procopio
authors.forename: E N
authors.initials: EN
authors.lastname: Forman
mesh_terms: D000740:Anemia / Q000209:etiology*; D000818:Animals; D001733:Bites and Stings / Q000150:complications; D001855:Bone Marrow Diseases / Q000175:diagnosis; D001856:Bone Marrow Examination; D002675:Child, Preschool; D003937:Diagnosis, Differential; D016873:Ehrlichiosis / Q000150:complications / Q000175:diagnosis* / Q000635:transmission; D005334:Fever / Q000209:etiology; D019337:Hematologic Neoplasms / Q000175:diagnosis; D006529:Hepatomegaly / Q000209:etiology*; D006801:Humans; D008297:Male; D009503:Neutropenia / Q000209:etiology*; D012237:Rhode Island; D012621:Seasons; D013163:Splenomegaly / Q000209:etiology*; D013921:Thrombocytopenia / Q000209:etiology*; D013987:Ticks