SHM Converge Scientific Abstract ePoster Gallery-A Tale of Two; Ehrlichiosis and Covid, a Combination Causing Fulminating Sepsis and Multiorgan Failure

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This case report describes a 77-year-old man with atrial fibrillation, coronary artery disease, diabetes, hypertension, and hyperlipidemia who presented after a mechanical fall but was already experiencing fever, malaise, chills, and fatigue. Initial testing showed hyponatremia, pancytopenia, marked transaminitis, acute kidney injury, elevated CPK, and a positive COVID NAAT. He was initially treated as having sepsis from COVID, but his condition worsened despite supportive care and broad-spectrum antibiotics. He developed persistent fevers, hypotension requiring pressors, severe anemia, bilateral subdural hematomas, a large retroperitoneal/iliopsoas hematoma, DIC, worsening renal and liver dysfunction, and altered mental status. After family discussion, a history of possible tick exposure was uncovered, and tick-borne testing later returned positive for Ehrlichia chaffeensis. The patient was transitioned to comfort care and died on hospital day 7.<br /><br />The report emphasizes that ehrlichiosis and COVID can present with overlapping nonspecific symptoms, including fever, malaise, confusion, and even respiratory complaints, creating a risk of anchoring bias and delayed diagnosis. Ehrlichiosis is a tick-borne illness most commonly caused in the U.S. by Ehrlichia chaffeensis, transmitted mainly by the lone star tick. Typical features include fever, myalgias, headache, pancytopenia, transaminitis, and hyponatremia, with severe disease more likely in older or immunocompromised patients and those with comorbidities such as diabetes. Diagnosis is best made with PCR, and first-line treatment is doxycycline for 7–10 days.<br /><br />The key message is that clinicians should maintain suspicion for ehrlichiosis, even during COVID infection, when patients have compatible lab abnormalities, seasonal risk, or tick exposure, to avoid serious morbidity and mortality.

Asset Subtitle

Jorgio Auguste

Meta Tag

Author List Deepinder Osahan, Ivan Kharchenko, Jiya Mulayamkuzhiyil, Jorgio Auguste, Shadan Mehraban, Victoria I. Oriuwa, Zohaib Ahmad

Category Clinical Vignettes

Concept Ehrlichiosis

Concept Polymerase Chain Reaction

Concept Doxycycline

Concept Pancytopenia

Concept Ehrlichia chaffeensis

Distinguished Non-Finalist

Presenter Organization Long Island Community Hospital

Presenting Author Jorgio Auguste

Track Adult

Keywords

ehrlichiosis

Ehrlichia chaffeensis

tick-borne illness

COVID-19 coinfection

pancytopenia

transaminitis

hyponatremia

doxycycline

anchoring bias

sepsis

Ehrlichiosis

Polymerase Chain Reaction

Doxycycline

Pancytopenia

Ehrlichia chaffeensis