title: Ehrlichiosis presenting as a life-threatening illness with features of the toxic shock syndrome.
abstract: OBJECTIVE
  To describe clinical and laboratory features of patients with severe ehrlichiosis, some of whom presented with toxic shock syndrome (TSS)-like illnesses, and to report, to our knowledge, the first documented fatal case of ehrlichiosis in a child.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Tertiary-care medical center.
  
  
  METHODS
  All patients with documented ehrlichiosis during a 3-year period, August 1, 1989, to July 31, 1992.
  
  
  RESULTS
  Eight patients (age range: 2 to 46 years) met clinical and serologic diagnostic criteria for ehrlichiosis. The mean interval from first contact with a physician to initiation of appropriate antibiotic therapy was 4.6 days (range: 1 to 11 days). All eight patients with ehrlichiosis had fever, chills, thrombocytopenia, and abnormal liver function test results. Most patients also had rash (seven), conjunctival hemorrhage or erythema (six), and leukopenia (six). Four cases met diagnostic criteria for TSS with fever, hypotension, rash, and multiorgan dysfunction. Two patients required mechanical ventilation, and one of these, a 6 1/2-year-old boy, died of complications of the infection. A ninth patient with probable ehrlichiosis also met diagnostic criteria for TSS.
  
  
  CONCLUSIONS
  Human ehrlichiosis can present as a severe, life-threatening illness that may resemble TSS. The diagnosis of ehrlichiosis was not considered by the physicians who first cared for these patients. Greater awareness of the potential severity of ehrlichiosis is needed to ensure that proper treatment is initiated early in the course of the disease.
authors.affiliation: Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri 63110.
authors.forename: C J
authors.initials: CJ
authors.lastname: Fichtenbaum
authors.forename: L R
authors.initials: LR
authors.lastname: Peterson
authors.forename: G J
authors.initials: GJ
authors.lastname: Weil
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D016873:Ehrlichiosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012772:Shock, Septic / Q000209:etiology*; D016896:Treatment Outcome