SHM Converge Scientific Abstract ePoster Gallery-Tick Tick Boom

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A 66-year-old immunocompromised man with rheumatoid arthritis on chronic steroids and active prostate cancer treatment presented with acute nausea, vomiting, fever, hypotension, and rapidly progressive neurologic symptoms, including altered mental status, slurred speech, aphasia, tremors, and inability to walk. Initial stroke evaluation with CT, CTA, and brain MRI was negative. Laboratory studies showed hyponatremia, acute kidney injury, thrombocytopenia, elevated liver enzymes, and lactic acidosis. He was initially treated for presumed sepsis and possible adrenal insufficiency, but his condition worsened, requiring ICU care.<br /><br />Because of severe thrombocytopenia, lumbar puncture could not be performed. An extensive infectious workup was sent, including Ehrlichia testing, which returned positive by PCR. Additional inflammatory markers, including ferritin, IL-2 receptor, LDH, and triglycerides, were markedly elevated, supporting a diagnosis of secondary hemophagocytic lymphohistiocytosis (HLH) triggered by ehrlichiosis.<br /><br />The case highlights Human Monocytic Ehrlichiosis (HME), caused by Ehrlichia chaffeensis, which is transmitted by the lone star tick and associated with white-tailed deer as the main reservoir. HME is endemic in the southeastern, south-central, and mid-Atlantic United States and usually presents in spring and summer, though this case occurred in the fall. Typical symptoms include fever, headache, and myalgias, but severe neurologic involvement is uncommon and can be life-threatening, especially in immunocompromised patients.<br /><br />The patient improved after treatment with doxycycline and steroids, with resolution of neurologic deficits and improvement in laboratory abnormalities before discharge. The case emphasizes the importance of careful history-taking, early recognition of tick-borne disease, and prompt treatment to reduce the high morbidity and mortality associated with severe ehrlichiosis and secondary HLH.

Asset Subtitle

Ankita Kapoor

Meta Tag

Author List Ankita Kapoor

Category Clinical Vignettes

Concept Human Monocytic Ehrlichiosis

Concept Ehrlichia chaffeensis

Concept Hemophagocytic Lymphohistiocytosis

Concept Doxycycline

Concept Tick

Distinguished Non-Finalist

Presenter Organization Washington University in St. Louis

Presenting Author Ankita Kapoor

Track Adult

Keywords

Human Monocytic Ehrlichiosis

Ehrlichia chaffeensis

secondary hemophagocytic lymphohistiocytosis

tick-borne disease

immunocompromised patient

neurologic symptoms

doxycycline treatment

lone star tick

prostate cancer

thrombocytopenia

Human Monocytic Ehrlichiosis

Ehrlichia chaffeensis

Hemophagocytic Lymphohistiocytosis

Doxycycline

Tick