SHM Converge Scientific Abstract ePoster Gallery-Acute Febrile Illness With Severe Liver Injury: An Uncommon Manifestation of Anaplasmosis

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This poster presents a rare case of severe liver injury from <strong>anaplasmosis</strong>, a tick-borne infection caused by <em>Anaplasma phagocytophilum</em>. The illness is endemic in the Northeastern United States, especially upstate New York, and typically causes fever, headache, myalgia, leukopenia, thrombocytopenia, and mild-to-moderate transaminitis. However, <strong>AST/ALT elevations above 1,000 U/L are exceptionally rare</strong>.

A <strong>37-year-old man</strong> with no significant past medical history presented in early October with recurrent fevers, chills, diffuse myalgias, headache, night sweats, pleuritic chest pain, and mild dyspnea after hiking in upstate New York. Initial evaluation showed <strong>leukopenia, thrombocytopenia, and elevated liver enzymes</strong>. He was started empirically on vancomycin, piperacillin-tazobactam, and doxycycline.

Despite treatment, his labs worsened over days 3–4, with <strong>AST peaking at 1,115 U/L and ALT at 1,034 U/L</strong>. The workup was negative for viral hepatitis, acetaminophen toxicity, Lyme disease, and babesiosis. On day 3, <strong>Anaplasma PCR returned positive</strong>, confirming the diagnosis. Broad-spectrum antibiotics were stopped, and doxycycline was continued. His fever resolved, liver tests began to improve before discharge, and he completed a 7-day doxycycline course with outpatient GI follow-up.

The key message is that <strong>anaplasmosis should remain on the differential for febrile patients with cytopenias and transaminitis, even when liver enzymes are extremely high</strong>. Prompt doxycycline treatment is essential to prevent complications such as worsening hepatic injury or multiorgan failure, particularly in endemic regions.

Asset Subtitle

Cheryl W. Zhang

Meta Tag

Author List Cheryl W. Zhang, Myint Aye

Category Clinical Vignettes

Concept Anaplasmosis

Concept Tick-Borne Infection

Concept Doxycycline

Concept Acute Febrile Illness

Concept Leukopenia

Distinguished Non-Finalist

Presenter Organization NYU Langone Brooklyn

Presenting Author Cheryl W. Zhang

Track Adult

Keywords

anaplasmosis

Anaplasma phagocytophilum

severe liver injury

transaminitis

tick-borne infection

AST elevation

ALT elevation

leukopenia

thrombocytopenia

doxycycline

Anaplasmosis

Tick-Borne Infection

Doxycycline

Acute Febrile Illness

Leukopenia