SHM Converge Scientific Abstract ePoster Gallery-Death in a Patient With Human Deficiency Virus Due to a Ticking Time Bomb

Pdf Summary

This case describes a 53-year-old man in Missouri with longstanding HIV/AIDS, prior intravenous drug use, seizures, and traumatic brain injury who presented with fever, confusion, hypotension, pancytopenia, acute kidney injury, and metabolic acidosis. He was initially treated for septic shock of unknown cause and later transferred to the ICU after developing respiratory failure. A CD4 count of 11 raised concern for severe immunosuppression and possible nonadherence to antiretroviral therapy, so empiric treatment for Pneumocystis pneumonia was started.<br /><br />Infectious Disease consultants later considered ehrlichiosis after family members reported possible tick exposure. However, diagnosis and treatment were delayed. A peripheral smear reviewed by pathology showed possible intracellular bacteria in a neutrophil, a clue consistent with ehrlichiosis, but bedside clinicians were not immediately alerted. Doxycycline was added only after the patient worsened further with seizures and hypotension. Ehrlichia testing later returned positive, confirming the diagnosis.<br /><br />Despite appropriate therapy once started, the patient deteriorated and died on hospital day 24 from multi-organ failure.<br /><br />The discussion emphasizes that ehrlichiosis is increasingly recognized, Missouri has a high incidence, and mortality is higher in patients with HIV coinfection. In reported HIV-coinfected cases, delayed diagnosis was strongly associated with worse outcomes. This patient’s presentation with fever and pancytopenia was typical, but clinicians focused on septic shock and opportunistic infection, while the possibility of ehrlichiosis was underappreciated. Diagnostic delay, attribution of illness to medication noncompliance, and lack of communication about the smear finding all contributed.<br /><br />The authors conclude that HIV and ehrlichiosis together can represent a “ticking time bomb,” where presumptive early doxycycline may be life-saving and delays can lead to irreversible organ failure and death.

Asset Subtitle

Catherine M. Jones

Meta Tag

Author List Catherine M. Jones, Hasan Naqvi

Category Clinical Vignettes

Concept Ehrlichiosis

Concept Pancytopenia

Concept Empiric Doxycycline

Concept Fever

Concept Shock

Distinguished Non-Finalist

Presenter Organization University of Missouri

Presenting Author Catherine M. Jones

Track Adult

Keywords

ehrlichiosis

HIV/AIDS

septic shock

pancytopenia

doxycycline

tick exposure

Missouri

respiratory failure

multi-organ failure

Pneumocystis pneumonia

Ehrlichiosis

Pancytopenia

Empiric Doxycycline

Fever

Shock