title: Human monocytic ehrlichiosis.
abstract: 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.
authors.affiliation: Johns Hopkins Vasculitis Center, Division of Rheumatology, Johns Hopkins Bayview Medical Center, Baltimore, Md 21224, USA. jstone@jhmi.edu
authors.forename: John H
authors.initials: JH
authors.lastname: Stone
authors.forename: Kerry
authors.initials: K
authors.lastname: Dierberg
authors.forename: Ghazaleh
authors.initials: G
authors.lastname: Aram
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Dumler
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004318:Doxycycline / Q000627:therapeutic use; D018469:Ehrlichia chaffeensis / Q000302:isolation & purification*; D016873:Ehrlichiosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D014890:Granulomatosis with Polyangiitis / Q000150:complications; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000382:microbiology; D016133:Polymerase Chain Reaction
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline