Grand Rounds at The Johns Hopkins Bayview Medical
Center Section Editors: David B. Hellmann, MD, Charles Weiner, MD,
Stephen D. Sisson, MD, The Johns Hopkins Hospital, Baltimore, Md; David S.
Cooper, MD, Contributing Editor, JAMA .
Author Affiliations: Johns Hopkins Vasculitis
Center, Division of Rheumatology (Dr Stone), Johns Hopkins University School
of Medicine (Ms Dierberg), Department of Medicine, Johns Hopkins Bayview Medical
Center (Drs Stone and Aram), and Division of Medical Microbiology, Department
of Pathology, Johns Hopkins University School of Medicine (Dr Dumler), Baltimore,
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.
Stone JH, Dierberg K, Aram G, Dumler JS. Human Monocytic Ehrlichiosis. JAMA. 2004;292(18):2263-2270. doi:10.1001/jama.292.18.2263