SHM Converge Scientific Abstract ePoster Gallery-Ehrlichiosis Presenting as Hemophagocytic Lymphohistiocytosis

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This case report describes a 70-year-old woman who presented with five days of fever, vomiting, diarrhea, and cough, along with leukopenia, thrombocytopenia, hyponatremia, kidney injury, elevated AST, and shock physiology requiring vasopressors. Because she worked at a campground and had pancytopenia, encephalopathy, and abnormal inflammatory markers, clinicians initially suspected severe tick-borne disease, leukemia, or hemophagocytic lymphohistiocytosis (HLH). She was started on meropenem and doxycycline, and further testing showed findings that increased concern for HLH, including elevated ferritin, CD25, hypertriglyceridemia, and cytopenias. A bone marrow biopsy was negative, and steroid treatment was given temporarily.<br /><br />Diagnosis was delayed because early tick-borne antibody testing was negative, and PCR results were not immediately available after transfer to a tertiary center. This created uncertainty and led to consideration of HLH-directed chemotherapy, which was ultimately withheld as the patient improved clinically. Later, the original hospital’s laboratory reported a positive Ehrlichia chaffeensis PCR, confirming human monocytic ehrlichiosis (HME). The patient was restarted on a seven-day course of doxycycline and recovered.<br /><br />The report emphasizes that HME is increasingly recognized in the northeastern and midwestern United States and often presents with nonspecific symptoms that can mimic other serious illnesses, including HLH and hematologic malignancy. It highlights the importance of using PCR early in the illness, since antibody testing may remain negative in the first week. Prompt recognition and treatment with doxycycline can prevent unnecessary invasive workup and more aggressive therapies.

Asset Subtitle

Tirth S. Talati

Meta Tag

Author List Abigail Baldwin-LeClair, Brisha B. Best, Gregory Hilditch, Kimberly Tena Diaz, Tirth S. Talati

Category Clinical Vignettes

Concept Human Monocytic Ehrlichiosis

Concept Fever

Concept Cytopenia

Concept Polymerase Chain Reaction

Concept Empiric Doxycycline

Distinguished Non-Finalist

Presenter Organization Cooper Medical School of Rowan University and Cooper University Health Care, Camden, New Jersey

Presenting Author Tirth S. Talati

Track Adult

Keywords

human monocytic ehrlichiosis

Ehrlichia chaffeensis

tick-borne disease

hemophagocytic lymphohistiocytosis

doxycycline

PCR testing

pancytopenia

fever

shock physiology

bone marrow biopsy

Human Monocytic Ehrlichiosis

Fever

Cytopenia

Polymerase Chain Reaction

Empiric Doxycycline