Human Monocytic Ehrlichiosis Associated With Myocarditis and Hemophagocytic Lymphohistiocytosis

Cherie N Dahm; Bin Q Yang; Daniel E Clark; William C Armstrong; Lynne W Stevenson

doi:10.1016/j.jaccas.2019.12.042

Human Monocytic Ehrlichiosis Associated With Myocarditis and Hemophagocytic Lymphohistiocytosis

JACC Case Rep. 2020 Mar 18;2(3):420-425. doi: 10.1016/j.jaccas.2019.12.042. eCollection 2020 Mar.

Authors

Cherie N Dahm^{1

2}, Bin Q Yang³, Daniel E Clark², William C Armstrong², Lynne W Stevenson²

Affiliations

¹ Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
² Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee.
³ Division of Cardiovascular Medicine, Barnes-Jewish Hospital/Washington University in St. Louis, St. Louis, Missouri.

Abstract

We present 3 cases at a single institution of human monocytic ehrlichiosis resulting in myocarditis and hemophagocytic lymphohistiocytosis. Contrary to previously published studies in which case fatalities were only as high as 1%, 2 of the 3 patients we discuss experienced a fulminant course resulting in death despite appropriate doxycycline treatment. Human monocytic ehrlichiosis is rarely a cause of myocarditis and hemophagocytic lymphohistiocytosis, but a high degree of suspicion is important because early empirical therapy may decrease morbidity and mortality. (Level of Difficulty: Intermediate.).

Keywords: ECG, electrocardiogram; EF, ejection fraction; HD, hospital day; HLH, hemophagocytic lymphohistiocytosis; HME, human monocytic ehrlichiosis; IV, intravenous; LV, left ventricular; OSH, outside hospital; PCR, polymerase chain reaction; TTE, transthoracic echocardiogram; cardiomyopathy; echocardiography; electrocardiogram.

Publication types

Case Reports