Yale University School of Medicine, 333 Cedar St., CT, 06510, New Haven, USA.
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
BMC Geriatr. 2021 Mar 12;21(1):178. doi: 10.1186/s12877-021-02129-6.
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.
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.
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.
全血细胞减少、发热和 D-二聚体升高是重要的临床发现。鉴别诊断包括血液系统恶性肿瘤、严重的 2019 年冠状病毒病（COVID-19）、蜱传疾病和其他病因。
我们报告了一例 95 岁女性的病例，她在 COVID-19 大流行期间的深秋在一所大型学术机构出现高热（103.6°F）、全血细胞减少和明显升高的 D-二聚体（32.21 mg/L；参考范围≤0.95 mg/L）。在外周血涂片检查后仍持续发热，遂进行了外周血涂片检查，发现符合埃立克体属的寄生虫。多西环素单药治疗导致症状改善和全血细胞减少症消退。在住院期间，胸部 CT 血管造影显示肺栓塞，食管胃十二指肠镜检查发现动静脉畸形。经过适当治疗后，她于住院第 7 天出院，此后恢复良好。
总体而言，我们的病例提供了一个非高龄人群中埃立克体病戏剧性和意外的表现。据我们所知，这是首例同时发生埃立克体病和肺栓塞的报告。
