Ladzinski Adam Timothy, Baker Melissa, Dunning Karla, Patel Prashant P
Department of Internal Medicine, Western Michigan University Homer Stryker M D School of Medicine, 1000 Oakland Drive, Kalamazoo, MI, USA.
Pathology Services of Kalamazoo, 601 John St., Kalamazoo, MI, USA.
IDCases. 2021 Jun 10;25:e01183. doi: 10.1016/j.idcr.2021.e01183. eCollection 2021.
Human Granulocytic Anaplasmosis (HGA) is an acute febrile tick-borne illness caused by the organism Patients often present with fever and a flu-like symptoms following a tick bite. In this case, the patient presented with subacute abdominal pain and severe hyponatremia consistent with SIADH. The patient was started on appropriate empiric antibiotics given the patient's tick exposure. Blood smear confirmed findings consistent with HGA and the patient continued antibiotic treatment with resolution of his symptoms. This case is unique in that the patient presented with severe hyponatremia that improved with treatment of the HGA. He also had subacute abdominal pain which is also a rare presentation of HGA. Our hope is that our case highlights the value of empiric treatment with appropriate monitoring to prevent downstream, severe sequelae from undiagnosed HGA. In the setting of climate change, increased duration of spp. tick life cycles with emerging regional distribution of the ticks, coinfections with and increased incidence of HGA in the last two decades, it is important to recognize this entity.
人粒细胞无形体病（HGA）是一种由该病原体引起的急性发热性蜱传疾病。患者在被蜱叮咬后常出现发热和流感样症状。在本病例中，患者表现为亚急性腹痛和与抗利尿激素分泌异常综合征相符的严重低钠血症。鉴于患者有蜱虫接触史，开始给予适当的经验性抗生素治疗。血液涂片证实了与HGA相符的发现，患者继续接受抗生素治疗，症状得以缓解。该病例的独特之处在于，患者出现严重低钠血症，经HGA治疗后有所改善。他还患有亚急性腹痛，这也是HGA的罕见表现。我们希望我们的病例能够突出经验性治疗并进行适当监测的价值，以预防未诊断出的HGA导致的严重后遗症。在气候变化的背景下，蜱虫生命周期延长、蜱虫出现新的区域分布、与其他病原体共感染以及过去二十年中HGA发病率增加，认识到这一疾病实体很重要。
