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A LJ6-year-old man with a h istory of non-Hodgkin lymphoma presents with myalgias. fever. and headache. Cen tral nervous symptoms worsened, and he became seriously ill and was admitted to the in tensive care unit for eval uation and treatment. Of note. the patien t stated he had been working in the woods and though t he may have had a tick bite. He last received treatment for lymphoma 2 years previously. Laboratory shows a leukocyte count of 3 ,200/pl, hemoglobi n 1 2 .3 g/dl, and platelet count LJ 7, 000/pl. An image from the peri pheral blood smear is shown below.
In terms of differentiating human monocytic erhlichiosis (HME) from human granulocytic ana-plasmosis (HGA), which of the following is true?
- Rash is found in about 30% of patients with HME, but is rare in patients with HGA
- Liver enzyme elevations are found in 50% of patients with HGA, but in less than 10% of patients with HME
- Only HGA has been proven to occur in New England
- Thrombocytopenia occurs in most patients with HME, but only rarely in HGA
Medicine
A. Rash is rare in HGA, but occurs in almost one-third ofHME cases. There are no differ-ences in the incidence of liver enzyme elevation or thrombocytopenia between HME and HGA. Both conditions have been found to occur in New England.
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