Ehrlichiosis Presenting as Hemophagocytic Lymphohistiocytosis in an Immunocompetent Adult

Tarang Pankaj Patel; Phillip Beck; Dennis Chairman; Hariharan Regunath

doi:10.1016/j.idcr.2020.e00813

Ehrlichiosis Presenting as Hemophagocytic Lymphohistiocytosis in an Immunocompetent Adult

IDCases. 2020 May 12:20:e00813. doi: 10.1016/j.idcr.2020.e00813. eCollection 2020.

Authors

Tarang Pankaj Patel¹, Phillip Beck², Dennis Chairman³, Hariharan Regunath²

Affiliations

¹ University of Missouri-Columbia, Department of Medicine, 1 Hospital Dr, Columbia, MO 65201, United States.
² University of Missouri-Columbia, Department of Medicine, Division of Infectious Diseases, 1 Hospital Dr, Columbia, MO 65201, United States.
³ University of Missouri-Columbia, Department of Medicine, Division of Pulmonary, Critical Care, and Environmental Medicine, 1 Hospital Dr, Columbia, MO 65201, United States.

Abstract

Hemophagocytic Lymphohistiocytosis (HLH) is a fatal, immunologic syndrome characterized by dysregulated tissue inflammation. HLH can be either primary or secondary; with the latter typically resulting from an infection. Diagnosis requires five or more of the following: fever, splenomegaly, cytopenia, hypertriglyceridemia, hemophagocytosis via biopsy, low natural killer (NK) cell activity, elevated ferritin and soluble CD25 level (sCD25). We present a case of HLH related to ehrlichiosis. In order to mount an effective immune response against microbes such as Ehrlichia chaffeensis, the host must have preserved NK cell function. Being that HLH Is characterized as a state of depleted NK cell function, It is crucial to investigate the role NK cell function has in the setting of HLH on the infectivity of Ehrlichia species.

Keywords: Ehrlichiosis; Hemophagocytic Lymphohistiocytosis; Human Monocytic Ehrlichiosis; Secondary HLH; Tick-Borne Illness.

Publication types

Case Reports