Human monocytic ehrlichiosis presenting as febrile diarrhea

I report a case of tick-borne ehrlichiosis in which the primary presentation suggested an infectious diarrhea, with impressive leukopenia and thrombocytopenia. Ehrlichiosis must be included in the differential diagnosis of febrile diarrhea in endemic areas because delay in therapy allows complications and sometimes death. In patients with apparent febrile diarrhea, the presence of leukopenia and thrombocytopenia or elevated aminotransferase values should alert the physician to look for a history of tick bites and consider treatment with doxycycline or tetracycline.