Leukopenia and Thrombocytopenia in a Patient with Early Lyme Borreliosis

Lyme disease, a multisystemic infection caused by the tickborne spirochete Borrelia burgdorferi [1], has recently been associated with a single case of leukopenia and thrombocytopenia [2]. We report the case of a patient with documented early Lyme borreliosis, leukopenia and thrombocytopenia, and elevated liver enzyme levels. In August 1995 a 22-year-old man who had previously been healthy developed fever, headache, myalgia, arthralgia of the knees and elbows, conjunctivitis, fatigue, and an erythematous area on the right thigh; this lesion was .--.3 cm in diameter. One week earlier he had been camping in forests in Slovenia but did not remember being bitten by a tick. Four days after the onset of symptoms, he returned to Switzerland and consulted the emergency unit of our hospital. He had not taken any medication for at least a half year and had no risk factors for HIV infection. Physical examination revealed a temperature of 39.6°C and a 5 X 7-cm erythematous oval lesion with partial central clearing typical of erythema migrans (EM), on the lateral side of the right thigh. The lymph nodes were not enlarged, and no signs of arthritis were found. Findings ofthe neurological examination were normal. No electrocardiographic abnormalities were noted. Significant laboratory values were as follows: WBC count, 2.2 X 10/L (neutrophil count, 1,3 X 10/L [47% band forms and 12.5% segmented cells]; 26.5% lymphocytes [lymphocyte count, 0.6 X I0/L]; 11,5% monocytes; 0.5% eosinophils; and 2% basophils). Morulae were not identified on review of the peripheral blood smear. Other laboratory values were as follows: platelet count, 98 X 10/L; hemoglobin, 158 giL; erythrocyte sedimentation rate, 4 mmIh; C-reactive protein, 59 mglL (norrnallevel, < 10 mg/L); serum aspartate aminotransferase, 96 UIL (normal level, <40 UIL); serum alanine aminotransferase, 91 U/L (normal level, <40 U/L); serum lactate dehydrogenase, 580 UIL (normal level, <460 U/L); and partial thromboplastin time, 72% (normal, 70%100%). Cultures of two blood samples drawn 1 hour apart before antibiotic treatment was started yielded no bacterial growth. A screening test (relative fluorescence; VIDAS Lyme, bioMerieux, Marcy L'Etoile, France) was used for detecting IgG and IgM antibodies to B. burgdorferi. Relative fluorescence values were as follows: <0.75, negative; 0.75-1.00, borderline; and > 1,00, positive. Western blot analysis was performed to confirm the diagnosis; for a positive result, a minimum of five bands, including three bands of the 93-kD antigen (pIOO), flagellin, p39, outer surface protein A (Osp A), and outer surface protein C (Osp C), had to be present. For a borderline result, five bands, including only two of the specified bands, had to be present. The relative fluorescence values of the screening test were 0.44 on day zero (day