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Ehrlichiosis is caused primarily by Ehrlichia chaffeensis and Ehrlichia ewingii.1,2 These obligate intracellular gram-negative cocco-bacilli are transmitted by arthropod vectors. They reside in vertebrate reservoirs and undergo a tick-mammal-tick cycle during which humans are dead-end hosts. The life cycle of E. chaffeensis is perpetuated predominantly via the A. americanum (Lone star) tick.1,2 During human infection, E. chaffeensis preferentially targets monocytes. Men are affected more often than women. Individuals between the ages of 65 and 69 had the highest incidence rate (IR) between 2008 and 2012.1,3 During this period, Oklahoma and Missouri had the highest IR at 30.9 and 26.3 per million, respectively.3 Patients with hematologic malignancies undergoing chemotherapy can have similar symptoms to those found in ehrlichiosis without being infected. However, in the appropriate setting, tick-borne illness should be considered. We present a case of severe illness and prolonged fevers due to ehrlichiosis in a patient who received chemotherapy for chronic lymphocytic leukemia (CLL).

Is it a Drug or a Bug? A Case of Chemotherapy and Immune Modulators Complicating the Diagnosis of Ehrlichiosis