METHODS: First Presentation
Given a high index of suspicion for potential tick-borne illness based on the history of possible bite, the rash appearance and worsening symptoms despite appropriate treatment for cellulitis, we obtained a complete blood count, basic metabolic panel, liver function testing, and a tickborne panel (Table 1). All testing was done in-house through Yale New Haven Hospital’s Department of Laboratory Medicine. He was found to be thrombocytopenic with a platelet count of 117x1000/uL (Table 1). He also had mild elevations of his liver enzymes (AST of 58U/L and ALT of 74U/L) (Table 1). The Babesia smear was negative during the course of stay (Table 1).
Table 1: Laboratory values obtained during the patient’s two admissions to the emergency department.