Division of Infectious Disease, Department of Internal Medicine, Inje University Ilsan Paik Hospital, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
Department of Laboratory Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
BMC Infect Dis. 2021 Nov 25;21(1):1184. doi: 10.1186/s12879-021-06869-z.
Human granulocytic anaplasmosis (HGA) is a systemic inflammatory response caused by the rickettsial bacterium Anaplasma phagocytophilum. Rhabdomyolysis and acute kidney injury (AKI) are rare complications of HGA. Here, we report a case of HGA concurrent with rhabdomyolysis and AKI in an elderly patient.
An 84-year old woman with a medical history of hypertension was hospitalised after two days of fever, dizziness, whole body pain, and general weakness. Laboratory investigations showed severe thrombocytopenia, leukopenia, impaired renal function, and elevated cardiac enzyme and myoglobin levels. On the day after admission, peripheral blood smear revealed morula inclusions in neutrophils, a suggestive finding of HGA. Real-time polymerase chain reaction (PCR) results indicated the presence of A. phagocytophilum. Antibiotics were de-escalated to doxycycline monotherapy. After 10 days of antibiotic treatment, laboratory tests showed complete recovery from HGA complicated with rhabdomyolysis and AKI.
HGA can lead to serious complications in patients with associated risk factors. Therefore, in patients with HGA accompanied by rhabdomyolysis, management with antibiotics and hydration should be initiated immediately, and not delayed until diagnostic confirmation.
人粒细胞无形体病（HGA）是由立克次体细菌嗜吞噬细胞无形体引起的全身性炎症反应。横纹肌溶解症和急性肾损伤（AKI）是 HGA 的罕见并发症。在此，我们报告了一例老年患者同时患有 HGA、横纹肌溶解症和 AKI 的病例。
一名 84 岁女性，有高血压病史，发热、头晕、全身疼痛和全身乏力两天后住院。实验室检查显示严重血小板减少、白细胞减少、肾功能受损以及心肌酶和肌红蛋白水平升高。入院后第二天，外周血涂片显示中性粒细胞中有桑葚包涵体，提示存在 HGA。实时聚合酶链反应（PCR）结果表明存在嗜吞噬细胞无形体。抗生素降级为多西环素单药治疗。抗生素治疗 10 天后，实验室检查显示 HGA 合并横纹肌溶解症和 AKI 完全恢复。
HGA 可导致伴发危险因素的患者出现严重并发症。因此，对于伴有横纹肌溶解症的 HGA 患者，应立即开始用抗生素和补液进行治疗，而不应等到确诊后再进行治疗。
