Id: 62: hemophagocytic lymphohistiocytosis caused by infection by ehrlichia chaffeensis: a case report.

We present a case of HLH triggered by severe infection with Ehrlichia chaffeensis in a patient taking methotrexate for seronegative spondyloarthropathy. A 45-year-old man with a history of ankylosing spondylitis taking methotrexate presented to a community hospital with acute onset of nausea, vomiting and diarrhea. Physical examination revealed a febrile patient with diffuse abdominal tenderness with splenomegaly and diffuse maculopapular rash involving the trunk and all extremities. Labs showed leukopenia and thrombocytopenia. Clinical course was complicated by development of acute renal failure, altered mental status and hypoxic respiratory failure requiring endotracheal intubation and mechanical ventilation. Plasmapheresis was initiated due to concern for thrombotic thrombocytopenic purpura with no response. A bone marrow biopsy was performed which revealed a tri-lineage hematopoiesis with increased number of histiocytes, including hemophagocytic forms. Further lab abnormalities included a hypofibrinogenemia, hyperferritinemia, low complement protein C3 and C4, and hypertriglyceridemia. Patient met diagnostic criteria for HLH and was transferred to our tertiary care hospital for further management. Given concern for tick borne disease, patient was started on doxycycline in addition to previously initiated broad spectrum antibiotics. Serum antibody testing was sent for Lyme disease, Rocky Mountain spotted fever and human Ehrlichiosis. Soluble interleukin-2-receptor alpha wa...
Source: Journal of Investigative Medicine - Category: Research Authors: Tags: Pulmonary/Critical Care Source Type: research