title: A 13-year old girl with pancytopenia at the presentation of a Borrelia hispanica infection: a case report and review of the literature.
abstract: BACKGROUND
  It is not uncommon that a child with a febrile illness of unknown etiology is admitted to the hospital. When the complete blood count reveals a pancytopenia, the diagnostic process can be a real challenge.
  
  
  METHODS
  A 13-year girl of Arab-Berber descent presented with abdominal pain and fever after a holiday in northwestern Morocco. A complete blood count revealed a pancytopenia and blood smear test results revealed spirochetes. Borrelia hispanica was identified by sequencing the 16S ribosomal ribonucleic acid gene. Our patient was treated with tetracyclines and during this treatment we saw full clinical and hematological recovery.
  
  
  CONCLUSIONS
  Borrelia hispanica is a known cause of tick-borne relapsing fever and is transmitted to humans through the bite of soft ticks of the genus Ornithodoros (Alectorobius). Although the link between tick-borne relapsing fever and thrombocytopenia has been documented, there are only a few case reports of tick-borne relapsing fever presenting with pancytopenia. To the best of our knowledge, there is no previous report of Borrelia hispanica presenting with pancytopenia.
authors.affiliation: Department of Pediatrics, Queen Paola Children's Hospital, Lindendreef 1, 2020, Antwerp, Belgium.|Department of Emergency Medicine, ZNA Middelheim, Antwerp, Belgium.
authors.forename: Irmin
authors.initials: I
authors.lastname: Leen
authors.affiliation: Department of Microbiology, ZNA Middelheim, Antwerp, Belgium.
authors.forename: Peggy
authors.initials: P
authors.lastname: Bruynseels
authors.affiliation: Department of Clinical Microbiology, Cliniques Universitaires UCL St-Luc, Brussels, Belgium.
authors.forename: Benoît Kabamba
authors.initials: BK
authors.lastname: Mukadi
authors.affiliation: Department of Pediatrics, Queen Paola Children's Hospital, Lindendreef 1, 2020, Antwerp, Belgium.
authors.forename: Mark
authors.initials: M
authors.lastname: van Oort
authors.affiliation: Department of Pediatrics, Queen Paola Children's Hospital, Lindendreef 1, 2020, Antwerp, Belgium. machielvdakker@gmail.com.|Department of Pediatric Hematology Oncology, UZ Brussel, Brussels, Belgium. machielvdakker@gmail.com.
authors.forename: Machiel
authors.identifier: http://orcid.org/0000-0003-2828-6226
authors.initials: M
authors.lastname: van den Akker
mesh_terms: D000293:Adolescent; D001898:Borrelia / Q000145:classification / Q000302:isolation & purification*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010198:Pancytopenia / Q000382:microbiology*; D012336:RNA, Ribosomal, 16S; D012061:Relapsing Fever / Q000382:microbiology*; D017422:Sequence Analysis, DNA; D013754:Tetracyclines / Q000008:administration & dosage
chemical_list: D012336:RNA, Ribosomal, 16S; D013754:Tetracyclines
keywords: Borrelia hispanica; Children; Pancytopenia