Human Monocytic Ehrlichiosis

Stone, John H. MD, MPH
Dierberg, Kerry
Aram, Ghazaleh MD
Dumler, J. Stephen MD

Johns Hopkins Vasculitis Center, Division of Rheumatology (Dr Stone), Johns Hopkins University School of Medicine (Ms Dierberg), Department of Medicine, Johns Hopkins Bayview Medical Center (Drs Stone and Aram), and Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine (Dr Dumler), Baltimore, Md.

Corresponding Author: John H. Stone, MD, MPH, Johns Hopkins Vasculitis Center, Johns Hopkins Bayview Medical Center, 5501 Hopkins Bayview Cir, 1B.23, Baltimore, MD 21224 ([email protected]).

Grand Rounds at The Johns Hopkins Bayview Medical Center Section Editors: David B. Hellmann, MD, Charles Weiner, MD, Stephen D. Sisson, MD, The Johns Hopkins Hospital, Baltimore, Md; David S. Cooper, MD, Contributing Editor, JAMA.

JAMA: The Journal of the American Medical Association 292(18):p 2263-2270, November 10, 2004.

A 56-year-old man with a history of Wegener granulomatosis presented with 6 days of sinus congestion, fever, malaise, myalgias, episcleritis, and a morbilliform rash. An exacerbation of Wegener granulomatosis was the principal concern because of the frequency of flares in that disease. The patient developed acute renal failure, thrombocytopenia, transaminitis, and, finally, severe myocarditis that led to congestive heart failure. Additional history-taking and the evolution of his clinical features led to empirical treatment with doxycycline for human monocytic ehrlichiosis (HME). The diagnosis of HME was confirmed by both a polymerase chain reaction assay for Ehrlichia chaffeensis and by the demonstration of morulae within peripheral blood mononuclear cells. The patient improved promptly following institution of doxycycline, and his cardiac function returned to normal over a period of 4 months.