"Flowers" in the blood: A novel paired erythrocyte arrangement in a patient with chronic fatigue syndrome following infectious mononucleosis

Carrie E Burdzinski

doi:10.5348/ijcri-201499-cr-10410

Abstract

Introduction: Chronic fatigue syndrome is a debilitating condition characterized by persistent fatigue, post-exertional malaise, myalgia, arthralgia, lymph node tenderness, impaired memory and concentration, autonomic irregularities, and other specific symptoms affecting multiple body systems. Diverse hypotheses have been investigated to ascertain the disease etiology. Some of these include metabolic and mitochondrial deficiencies, exposure to environmental toxins, dysautonomia associated with orthostatic intolerance, autoimmune reactions, neuroendocrine aberrations, and chronic viral infections. However, a consistently observed biomarker for chronic fatigue has not been identified. A comprehensive, standardized strategy for accurate diagnosis and successful treatment remains elusive. Case Report: A 28-year-old Caucasian female presented with chronic fatigue persisting for nine months following infectious mononucleosis. Laboratory evaluation excluded classic causes of fatigue. Peripheral blood smear examination revealed numerous pairs of unusual nondiscocytic C-shaped erythrocytes, coupled in perpendicular crosses resembling four-petalled flowers. The presence of the erythrocyte pairs abated with the patient’s recovery from chronic fatigue syndrome over a 24-month period. This erythrocyte arrangement has not been reported elsewhere in medical literature. Conclusion: A novel erythrocyte “flower” formation was identified in a patient with chronic fatigue syndrome. The presence of this arrangement paralleled the course of the illness and was no longer observed upon recovery. The physiological relevance of the structure remains a subject for future research. Several hypotheses are suggested, including enhanced membrane deformability resulting from elevated catecholamine levels, and immune-mediated agglutination, possibly stemming from viral infection. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 5 No. 8, August 2014. ISSN – [0976-3198] Int J Case Rep Images 2014;5(8):562–566. www.ijcasereportsandimages.com Burdzinski 562 CASE REPORT OPEN ACCESS “Flowers” in the blood: A novel paired erythrocyte arrangement in a patient with chronic fatigue syndrome following infectious mononucleosis

Highlights

Chronic fatigue syndrome is a debilitating condition characterized by persistent fatigue, post-exertional malaise, myalgia, arthralgia, lymph node tenderness, impaired memory and concentration, autonomic irregularities, and other specific symptoms affecting multiple body systems
Chronic fatigue syndrome (CFS) is a debilitating condition characterized by persistent fatigue unresponsive to bed rest, postexertional malaise, myalgia, arthralgia, lymph node tenderness, impaired memory and concentration, autonomic irregularities, and other specific symptoms affecting multiple body systems [1]
I have presented a novel erythrocyte arrangement detected in a patient with chronic fatigue syndrome, the presence of which paralleled the course of the illness

Summary

Introduction

Chronic fatigue syndrome (CFS) is a debilitating condition characterized by persistent fatigue unresponsive to bed rest, postexertional malaise, myalgia, arthralgia, lymph node tenderness, impaired memory and concentration, autonomic irregularities, and other specific symptoms affecting multiple body systems [1]. A comprehensive, standardized strategy for accurate diagnosis and successful treatment remains elusive In this case report, I describe a patient with chronic fatigue syndrome subsequent to infectious mononucleosis. This erythrocyte finding has not been reported elsewhere in medical literature It is suggested as being potentially associated with CFS. Physician workup: A 28-year-old Caucasian female presented with fatigue persisting for nine months following infectious mononucleosis (IM) She reported physical exhaustion, widespread muscle and tissue pain, tender lymph nodes, sleep disturbances, and sensitivity to light and sound. Erythrocyte flowers continued to be identified on blood films collected and surveyed at periodic intervals throughout the duration of the patient’s illness, persisting 15 more months. Concurrent with recovery from chronic fatigue, the paired erythrocyte flowers were no longer detected in several blood films examined at two-year follow-up

Findings

DISCUSSION

CONCLUSION