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A case of Ehrlichiosis mimicking course of thrombotic thrombocytopenic purpura requiring hemodialysis
Author(s) -
Sowers K.,
WhaleyConnell A.,
Khanna R.,
Katyal A.
Publication year - 2005
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1492-7535.2005.1121bf.x
Subject(s) - medicine , thrombotic thrombocytopenic purpura , hemodialysis , ehrlichiosis , gastroenterology , leukopenia , schistocyte , sepsis , oliguria , surgery , renal function , chemotherapy , platelet , veterinary medicine , tick
We present an atypical presentation of Ehrlichiosis induced sepsis requiring hemodialysis. Ehrlichiosis is a common tick‐borne illness in Missouri, and in this case mimicks the course of thrombotic thrombocytopenic purpura (TTP). A 48‐year‐old male with a history of marginal zone lymphoma had received radiation and chemotherapy with fludarabine. He was admitted to oncology service for evaluation of nausea and vomiting and generalized malaise. His initial laboratory data revealed platelet count 16,000 mm 3 , WBC 3,800 mm 3 , AST 327 units/L, ALT 185 units/L, BUN/Creatinine 53 mg/dl/3.8 mg/dl. Because the peripheral smear showed a morulae consistent with human granulocytic Ehrlichiosis, intravenous doxycycline 100 mg twice daily was initiated. Acute renal failure was thought due to hemodynamic changes, but the role of TTP remained in the differential diagnosis. On hospital day two, he became confused and lethargic and continued to be febrile. Hours later, he developed tonic‐clonic seizures and became hypotensive. A clinical diagnosis of TTP was made. Peripheral smear showed only a few schistocytes, inconsistent with TTP. Microangiaopthic anemia, thrombocytopenia, sepsis with DIC, and multi‐organ failure sustained the acute renal failure. Hemodialysis was used for ARF over the next several days in conjuction with IV doxycycline. The patient improved without plasmapharesis. Kidney function returned back to normal in due course of time. A final diagnosis of ehrlichia‐induced sepsis with ARF was made. Conclusion: Ehrlichiosis is endemic in Missouri and usually presents with thrombocytopenia, leukopenia, and elevated liver function tests; however it rarely presents with sepsis. The course of this case was made unusual possibly due to chemotherapy, fludarabine for the treatment of lymphoma, which can commonly cause micrangiopathic anemia, myelosuppression, and even a leukopenia for several years afterwards. This presentation mimicking TTP can be confusing but has previously been documented as a complication of severe Ehrlichiosis in the immunocompromised state.