Red cell agglutination, anaemia and a dermatomal rash

Abstract

A woman aged 68 years with a history of hypertension presented to her general practitioner (GP) with a one-day history of a painful rash on the left side of her forehead. The eruption was preceded by a two-day history of burning pain. She had no ocular symptoms. Clinical examination showed a unilateral dermatomal vesicular rash consistent with a left-sided varicella-zoster virus (VZV) infection of the first branch of the trigeminal nerve (shingles). The patient did not smoke and had an alcohol intake of approximately two standard drinks per day and two alcohol-free days per week. Incidentally, she was also scheduled to review the results of her annual blood examination results taken five days earlier. The pathology service provider used routinely includes lactate dehydrogenase (LDH) in requests for liver function tests (LFTs). Her blood test results (Table 1) showed mild anaemia, reticulocytosis, macrocytosis, hyperbilirubinaemia and elevated LDH. Red cell agglutination and polychromasia were reported on the blood film