SHM Converge Scientific Abstract ePoster Gallery-Hickam's Dictum at the Bedside: When Norovirus and Ebv Serology Obscure Underlying Anaplasmosis

Hickam's Dictum at the Bedside: When Norovirus and Ebv Serology Obscure Underlying Anaplasmosis

Pdf Summary

This case highlights how overlapping infections and misleading test results can delay diagnosis in a patient with human granulocytic anaplasmosis (HGA), a tick-borne illness caused by <em>Anaplasma phagocytophilum</em>. HGA typically presents with fever, cytopenias, and transaminitis, and usually improves quickly with doxycycline.

In this report, gastrointestinal symptoms complicated the picture because norovirus can produce similar symptoms, making it harder to identify the underlying cause. Serologic testing also added confusion: Epstein-Barr virus (EBV) IgM can be nonspecific and may be falsely positive due to cross-reactivity or polyclonal B-cell activation. Findings such as early EBNA positivity and negative EBV DNA argued against acute EBV infection.

The key lesson is Hickam’s dictum: a patient may have more than one disease at the same time. Clinicians should not anchor on a single diagnosis when test results and symptoms do not fully fit. Instead, serologies should be interpreted in clinical context, and PCR testing should be used when results are discordant. Prompt recognition of HGA matters because early doxycycline treatment prevents complications.

Asset Subtitle

Jong Seok Ahn

Meta Tag

Author List Bettina Gabrielle v. Tenorio, Jong Seok Ahn, Jun Ki Jeon, Omar Abdelghffar

Category Clinical Vignettes

Concept Human Granulocytic Anaplasmosis

Concept Fever

Concept Hickams Dictum

Concept Doxycycline

Concept Cytopenia

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Jong Seok Ahn

Track Adult

Keywords

human granulocytic anaplasmosis

HGA

Anaplasma phagocytophilum

tick-borne illness

doxycycline

norovirus

Epstein-Barr virus

EBV IgM

serologic testing

Hickam's dictum

Human Granulocytic Anaplasmosis

Fever

Hickams Dictum

Doxycycline

Cytopenia