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Background
Lyme disease is a tick-borne illness due to an infection with Borrelia burgdorferi , a spirochetal bacterium that is transmitted by a cutaneous tick bite, specifically Ixodes scapularis or 'deer tick'. 1 In order for infection to occur, the tick must typically remain attached to the skin for more than 36-48 h. 1 2
B burgdorferi is the most common vector-borne illness in the USA, with incidence peaking in the summer months of May through August. 2- - 6 Geographically, the predominance of cases occur in northeastern USA, though other coastal areas have reported cases of infection. 3 6 7
There are three stages of clinical manifestations in Lyme disease. 1 3 4 8 9 Stage 1 occurs within weeks after infection and patients often report a 'flu-like' illness, lymphadenopathy and the classical erythema migrans (EM) rash, that is, an erythematous patch with a central clearing. 1 7 10- - 12 Stage 2 occurs within weeks to months after infection and presents with more systemic involvement; patients may experience migratory arthalgias, myalgias, cranial nerve palsies and atrioventricular-node heart block, along with general systems of fatigue, malaise and multiple EM lesions. 1 8 9 11 13- - 15 Stage 3 occurs months to years after infection and classically presents with a recurrent monoarthritis or oligoarthritis of the large joints, polyneuropathy, neurological manifestations and an acrodermatitis chronica atrophicans skin rash. 1 8 10 11 13
Despite the fact that patients may present with diffuse symptoms as described above, pancytopenia, haemolytic anaemia and lower extremity oedema are very rare manifestations of Lyme disease.
We present a 49-year-old Caucasian man who presents with a subacute course of fatigue, shortness of breath, weakness and unilateral lower extremity oedema, who was found to have pancytopenia, with positive serology for Lyme disease.
In this case study, we are aiming to acknowledge and establish an association of pancytopenia with Lyme disease and ultimately provide a medical framework for both the diagnosis of this condition with an atypical initial presentation and inclusion of this rare correlation in the formulation of the differential diagnosis.
Case presentation
A 49-year-old man with a medical history significant for alcohol abuse was brought in by ambulance to the emergency department (ED) with 10 days of constant fevers, chills,...