Fever, pancytopenia, and elevated D-dimer in a 95‐year‐old woman with ehrlichiosis: a case report

• Main Authors: Christopher Radcliffe, Cynthia Tsay, Kimberly Glerum, Jane Liao, George Goshua, Gerard Kerins
• Format: Article
• Language: English
• Published: BMC 2021-03-01
• Series: BMC Geriatrics
• Subjects: Ehrlichiosis; Pancytopenia; Pulmonary embolus; Case report
• Online Access: https://doi.org/10.1186/s12877-021-02129-6

Abstract Background 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. Case presentation 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. Conclusions 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.