A case of acute monocytic ehrlichiosis with prominent neurologic signs.
Human monocytic ehrlichiosis is a recently described tick-borne infection with the rickettsial organism Ehrlichia chaffeensis. We describe a patient with documented E chaffeensis infection and multiple organ system involvement. Prominent neurologic symptoms and signs included severe headache, meningismus, and altered mental status. Additional neurologic findings included unilateral arm weakness and a Bell's palsy. Biopsy of brain and meninges demonstrated an infiltrate of atypical lymphoid cells in the leptomeninges with involvement of blood vessel walls and extension into the Virchow-Robin spaces. Bone marrow biopsy revealed fibrin-ringed granulomas. The patient also developed a nonspecific increase in immunoglobulin production. Host immune response may play a critical role in the pathophysiology of ehrlichiosis.
Grant
A C
AC
Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
Hunter
S
S
Partin
W C
WC
D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology; D016873:Ehrlichiosis / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008214:Lymphocytes / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000382:microbiology*; D013346:Subarachnoid Space / Q000166:cytology / Q000382:microbiology