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.