A case of ehrlichiosis with meningoencephalitis and multi-organ failure

Abstract

Ehrlichiosis is a bacterial illness primarily transmitted through the bite of an infected lone star tick. According to the Centers for Disease Control (CDC), the United States is experiencing a rising number of reported cases, with a case fatality rate of approximately 1 %. The disease typically manifests as a non-specific flu-like illness, however in rare cases, it can progress to severe disease with multi-organ failure and mortality. We present a case of a 70-year-old male who was transferred to the intensive care unit of our facility for the management of septic shock associated with multi-organ failure. He had a history of recent exposure to multiple tick-bites while performing yard work. He was diagnosed with Ehrlichiosis based on positive serum IgM and IgG antibodies against Ehrlichia chaffeenesis. A lumbar puncture also confirmed meningoencephalitis. The patient completed intravenous Doxycycline treatment for 14 days, resulting in clinical improvement. Identifying Ehrlichia as the causal organism for meningoencephalitis and severe disease is challenging due to its low prevalence. This case emphasizes the significance of promptly suspecting and identifying ehrlichiosis in patients who exhibit meningoencephalitis symptoms or end-organ failure and have a recent history of engaging in outdoor activities with a risk of exposure to ticks, especially in endemic regions. It also signifies the importance of empirically treating with doxycycline even before its diagnosis as delay in providing doxycycline can significantly lead to more complications compared with patients who receive it early on during hospital admission.