BMC Geriatrics (Mar 2021)

Fever, pancytopenia, and elevated D-dimer in a 95‐year‐old woman with ehrlichiosis: a case report

  • Christopher Radcliffe,
  • Cynthia Tsay,
  • Kimberly Glerum,
  • Jane Liao,
  • George Goshua,
  • Gerard Kerins

DOI
https://doi.org/10.1186/s12877-021-02129-6
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 4

Abstract

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Abstract Background Pancytopenia, fever, and elevated D-dimer are significant clinical findings. The differential diagnosis includes hematological malignancies, severe coronavirus disease 2019 (COVID-19), tick-borne illnesses, and other etiologies. Case presentation We report the case of a 95-year-old woman who presented with high fever (103.6 °F), pancytopenia, and markedly elevated D-dimer (32.21 mg/L; reference range ≤ 0.95 mg/L) in late-autumn during the COVID-19 pandemic at a large academic institution. After remaining persistently febrile, a peripheral blood smear was ordered and revealed parasites consistent with Ehrlichia spp. Doxycycline monotherapy led to symptomatic improvement and resolution of her pancytopenia. During her hospital stay, a computed tomography angiogram of the chest revealed pulmonary emboli, and esophagogastroduodenoscopy uncovered arteriovenous malformations. After appropriate treatment, she was discharged on hospital day 7 and has since done well. Conclusions Overall, our case offers a dramatic, unexpected presentation of ehrlichiosis in a nonagenarian. To our knowledge, this is the first report of concurrent ehrlichiosis and pulmonary embolus.

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