Int J Case Rep Images 2014;5(8):562?566.
www.ijcasereportsandimages.com
Burdzinski, Carrie E
?Flowers? in the blood: A novel paired erythrocyte arrangement in a patient with chronic fatigue syndrome following infectious mononucleosis
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 immunemediated agglutination, possibly stemming from viral infection.
