Course: Retinal Hemorrhage Associated with Human Granulocytic Anaplasmosis

CME Credits: 1.00

Released: 2023-12-26

A 51-year-old female with history of a recent motor vehicle crash 1 month prior that was complicated by postconcussive syndrome presented to the emergency department with high-grade fever, headache, nausea, vomiting, dizziness, diffuse arthralgias, and new-onset worsened vision that had developed over 3 days. She resided in central Pennsylvania and had been exposed to deer around her home. The physical examination revealed complete vision loss in the left eye with relative afferent pupillary defect. Skin examination was unremarkable without any rashes. Evaluation by ophthalmologist suggested vitreous hemorrhage in the left eye and possible retinal detachment in the right eye. Serum laboratory evaluation showed hyponatremia, leukopenia, thrombocytopenia (52,000 ?L; reference range, 140,000 to 440,000 ?L), and mild transaminitis. Peripheral smear showed neutrophils with intracytoplasmic large dark blue basophilic inclusions resembling anaplasmosis. Brain magnetic resonance imaging showed prominent left retinal hemorrhage and small focus of right retinal hemorrhage (Figure). With the high suspicion for anaplasmosis infection, the patient was empirically treated with doxycycline, 100 mg, twice a day. Later, the diagnosis of anaplasmosis was confirmed by serum polymerase chain reaction test. Meanwhile, results of Lyme and Ehrlichia serology were negative. The patient was discharged home after her condition showed improvement and stabilized with a plan to complete 10 days of doxycycline therapy. In an outpatient ophthalmology follow-up after a month, funduscopic evaluation revealed improvement in the bilateral vitreous hemorrhage and identified bilateral peripheral intraretinal hemorrhages without any detachment.

To identify the key insights or developments described in this article

View Full Course