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Grand Rounds
Clinician's Corner
November 10, 2004

Human Monocytic Ehrlichiosis

Author Affiliations

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, Md.

JAMA. 2004;292(18):2263-2270. doi:10.1001/jama.292.18.2263

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.