Fatal human monocytic ehrlichiosis: a case study

Human ehrlichiosis is the term for a collection of tick-borne diseases caused primarily by obligate intracellular bacteria of the Ehrlichia species. Ehrlichiosis is characterized by a mild to severe illness, with approximately 3-5% of cases proving fatal despite receiving appropriate care. This report presents the case of a 60 year-old woman who was found collapsed and unresponsive in her home after an indeterminate time; possibly for up to 48 h. Despite rigorous resuscitative care and antibiotic treatment, the patient lapsed into multi-organ failure and died. Subsequent analysis by microscopic examination, PCR and immunohistochemistry revealed the patient died from an infection of Ehrlichia chaffeensis. Clinicians and pathologists must be aware of this emergent disease in order to make a timely and appropriate diagnosis. Discussion of the patient's clinical, laboratory and autopsy findings as well as treatment of Ehrlichia chaffeensis infections is presented.