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Cytopenias and clonal expansion of gamma/delta T-cells in a patient with anaplasmosis: a potential diagnostic pitfall.

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.
PMID
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Authors

Mayor MeshTerms

Pancytopenia

Keywords
Journal Title journal of clinical and experimental hematopathology : jceh
Publication Year Start




 
PMID- 28331130
OWN - NLM
STAT- MEDLINE
DA  - 20170323
DCOM- 20170410
LR  - 20170410
IS  - 1880-9952 (Electronic)
IS  - 1346-4280 (Linking)
VI  - 56
IP  - 3
DP  - 2017
TI  - Cytopenias and clonal expansion of gamma/delta T-cells in a patient with
      anaplasmosis: a potential diagnostic pitfall.
PG  - 160-164
LID - 10.3960/jslrt.56.160 [doi]
AB  - 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.
FAU - Marko, Daniel
AU  - Marko D
AD  - Department of Pathology, University of Manitoba.
FAU - Perry, Anamarija M
AU  - Perry AM
FAU - Ponnampalam, Arjuna
AU  - Ponnampalam A
FAU - Nasr, Michel R
AU  - Nasr MR
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Japan
TA  - J Clin Exp Hematop
JT  - Journal of clinical and experimental hematopathology : JCEH
JID - 101141257
RN  - 0 (Receptors, Antigen, T-Cell, gamma-delta)
SB  - IM
MH  - Aged
MH  - Anaplasmosis/*diagnosis
MH  - Cell Proliferation
MH  - Clone Cells/pathology
MH  - Diagnosis, Differential
MH  - Humans
MH  - Male
MH  - *Pancytopenia
MH  - Receptors, Antigen, T-Cell, gamma-delta/*analysis
MH  - T-Lymphocytes/pathology
EDAT- 2017/03/24 06:00
MHDA- 2017/04/11 06:00
CRDT- 2017/03/24 06:00
AID - 10.3960/jslrt.56.160 [doi]
PST - ppublish
SO  - J Clin Exp Hematop. 2017;56(3):160-164. doi: 10.3960/jslrt.56.160.

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