Cytopenias and clonal expansion of gamma/delta T-cells in a patient with anaplasmosis: a potential diagnostic pitfall.
J Clin Exp Hematop
; 56(3): 160-164, 2017.
Article
in En
| MEDLINE
| ID: mdl-28331130
ABSTRACT
Human granulocytic anaplasmosis is a rare, tick-borne infectious disease caused by Anaplasma phagocytophilum. Herein, we report a rare case of human granulocytic anaplasmosis associated with cytopenias and clonal expansion of gamma/delta T-cells in the bone marrow. A 77-year old man presented multiple times to the emergency department complaining of muscle weakness. Complete blood count detected cytopenias and peripheral blood smear showed pseudo Pelger-Huet neutrophils. These findings prompted bone marrow evaluation with ancillary studies including flow cytometry, karyotyping and T-cell rearrangement studies. Careful examination of peripheral blood smear revealed very rare neutrophils with intracytoplasmic inclusions, suggestive of ehrlichiosis/anaplasmosis. Bone marrow evaluation showed dyserythropoiesis, dysmegakaryopoiesis and prominence of hemophagocytic histiocytes. Furthermore, an increased number of T-cells was seen in the bone marrow and flow cytometry showed excess of gamma/delta T-cells, while T-cell rearrangement studies detected a T-cell clone. Serologic evaluation confirmed the diagnosis of anaplasmosis. This case nicely illustrates hematologic sequelae of infection with Anaplasma and potential diagnostic pitfalls, such as myelodysplastic syndrome and T-cell lymphoproliferative disorder. To our knowledge, this is the first reported case of clonal expansion of gamma/delta T-cells associated with anaplasmosis. Pathologists should be careful and vigilant when screening peripheral blood smears, as they are often the first to raise the suspicion of anaplasmosis.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pancytopenia
/
Receptors, Antigen, T-Cell, gamma-delta
/
Anaplasmosis
Type of study:
Diagnostic_studies
Limits:
Aged
/
Humans
/
Male
Language:
En
Journal:
J Clin Exp Hematop
Journal subject:
HEMATOLOGIA
/
PATOLOGIA
Year:
2017
Document type:
Article