title: Human granulocytic ehrlichiosis presenting with acute renal failure and mimicking thrombotic thrombocytopenic purpura. A case report and review.
abstract: We present the case of an elderly female patient presenting with recurrent acute renal failure, fever, altered mental status, abdominal pain, thrombocytopenia and a small number of fragmented red cells on peripheral smear mimicking recurrent thrombotic thrombocytopenic purpura (TTP). Eventually, however, she was diagnosed to have human granulocytic ehrlichiosis (HGE), and after treatment for HGE her clinical and laboratory abnormalities resolved. Ehrlichiosis mimicking TTP, diagnosed at postmortem examination, has been described in a single prior case. As illustrated in this case, there are potential difficulties in diagnosing HGE after plasma exchange, blood transfusion and immunosuppressive therapy. Ehrlichiosis, a potentially curable disease, should be considered in the differential diagnosis of thrombotic microangiopathic disorders.
authors.affiliation: Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA. modix001@tc.umn.edu
authors.forename: K S
authors.initials: KS
authors.lastname: Modi
authors.forename: D C
authors.initials: DC
authors.lastname: Dahl
authors.forename: R O
authors.initials: RO
authors.lastname: Berkseth
authors.forename: R
authors.initials: R
authors.lastname: Schut
authors.forename: E
authors.initials: E
authors.lastname: Greeno
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000032:analysis; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D004318:Doxycycline / Q000627:therapeutic use; D004536:Ehrlichia / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D016873:Ehrlichiosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006098:Granulocytes / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D011696:Purpura, Thrombocytopenic / Q000175:diagnosis*
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D004269:DNA, Bacterial; D004318:Doxycycline