Department of Internal Medicine, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, PA, USA.
Department of Critical Care Medicine, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, PA, USA.
Am J Case Rep. 2024 Jul 15;25:e943966. doi: 10.12659/AJCR.943966.
BACKGROUND Anaplasmosis, or human granulocytic anaplasmosis (HGA), is a tick-borne diseased caused by a gram-negative, intracellular bacterium, Anaplasma phagocytophilum. HGA usually presents with mild symptoms but can be more severe. This report describes a 67-year-old male resident of rural Pennsylvania, admitted to the hospital after a fall, who developed fatal acute respiratory distress syndrome (ARDS) associated with human granulocytic anaplasmosis (HGA) following transmission of Anaplasma phagocytophilum by a tick bite (Ixodes scapularis). CASE REPORT A 67-year-old man, resident of rural Pennsylvania, with history of diabetes mellitus, presented after falling from a 7-foot-tall ladder, sustaining right-sided hemopneumothorax, multiple right rib fractures, and unstable T12 vertebra fracture. He required tube thoracostomy and underwent T9-L2 posterior spinal fusion surgery. His initial labs showed leukopenia, thrombocytopenia, and elevated transaminase levels. His course was complicated by cardiac arrest and acute respiratory failure, consistent with severe ARDS. He received high positive end-expiratory pressure (PEEP) ventilation, prone positioning, and neuromuscular paralysis to improve refractory hypoxemia. Bronchoalveolar lavage (BAL) for bacterial, fungal, viral pathogens, Covid-19, respiratory viral panel, Mycoplasma pneumoniae, and Chlamydia pneumoniae were negative. his family withdrew medical care, knowing the patient's own wishes, and the patient died. Polymerase chain reaction (PCR) for Anaplasma DNA came back positive after the patient's death. His peripheral smear was then examined, showing morulae inside the cytoplasm of infected neutrophils. CONCLUSIONS This report describes the atypical presentation of a case of HGA and highlights that in parts of the world where tick-borne diseases are endemic, disease awareness, high index of clinical suspicion, and early diagnosis and management are required.
嗜吞噬细胞无形体病（HGA）又称人粒细胞无形体病，是一种由革兰氏阴性、细胞内细菌嗜吞噬细胞无形体引起的蜱传疾病。HGA 通常表现为轻度症状，但也可能更为严重。本报告描述了宾夕法尼亚州农村地区的一位 67 岁男性居民，在跌倒后被送往医院，由于 ticks（Ixodes scapularis）叮咬传播嗜吞噬细胞无形体，他患上了致命性急性呼吸窘迫综合征（ARDS），并伴有 HGA。
一位 67 岁的男性，居住在宾夕法尼亚州农村，有糖尿病史，从 7 英尺高的梯子上摔下来后出现右侧血气胸、多处右侧肋骨骨折和不稳定的 T12 椎体骨折，需要进行胸腔引流管和 T9-L2 后路脊柱融合术。他的初始实验室检查显示白细胞减少、血小板减少和转氨酶水平升高。他的病情因心脏骤停和急性呼吸衰竭而复杂化，与严重的 ARDS 一致。他接受了高呼气末正压通气（PEEP）、俯卧位和神经肌肉麻痹，以改善难治性低氧血症。他的支气管肺泡灌洗液（BAL）用于检测细菌、真菌、病毒病原体、Covid-19、呼吸道病毒小组、肺炎支原体和肺炎衣原体，结果均为阴性。他的家人了解到患者的个人意愿后，停止了医疗护理，患者随后死亡。PCR 检测显示，在患者死后，嗜吞噬细胞无形体 DNA 的聚合酶链反应（PCR）结果为阳性。随后检查了他的外周涂片，显示受感染中性粒细胞的细胞质内有菌栓。
本报告描述了一例 HGA 的非典型表现，并强调在蜱传疾病流行的世界某些地区，需要提高疾病意识、临床高度怀疑、早期诊断和管理。
