Ehrlichia-induced hemophagocytic lymphohistiocytosis in a pediatric kidney transplant recipient

Pediatr Transplant. 2022 Feb;26(1):e14134. doi: 10.1111/petr.14134. Epub 2021 Sep 30.

Abstract

Background: Kidney transplant patients are susceptible to a variety of infections in the post-transplant period due to the use of immunosuppressant medications. Ehrlichiosis is a rare infection in solid organ transplant recipients with signs and symptoms that mimic rejection and other viral infections. Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyperinflammatory syndrome that can be triggered by infections.

Methods: We describe a pediatric kidney transplant recipient who experienced secondary HLH due to ehrlichiosis within the initial post-transplant month.

Result: Our patient improved after treatment with doxycycline, corticosteroids, and intravenous immunoglobulin (IVIG).

Conclusion: Clinicians should consider infections such as ehrlichiosis as a potential cause of illness in febrile solid organ transplant recipients in immediate post-transplant period, especially when accompanied by a compatible exposure history.

Keywords: ehrlichiosis; fever; hemophagocytic lymphohistiocytosis; kidney transplant.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Diagnosis, Differential
  • Ehrlichiosis / diagnosis*
  • Ehrlichiosis / etiology
  • Ehrlichiosis / physiopathology*
  • Fever / etiology
  • Humans
  • Kidney Transplantation*
  • Lymphohistiocytosis, Hemophagocytic / diagnosis*
  • Lymphohistiocytosis, Hemophagocytic / etiology*
  • Male
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / etiology
  • Postoperative Complications / physiopathology