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Unknown female 42 Fatal seronegative human ehrlichiosis in a patient with human immunodeficiency virus disease.
The first confirmed case of disease due to Ehrlichia chaffeensis occurring in a patient with human immunodeficiency virus type 1 (HIV-1) is reported. A 42 year-old Arkansas woman with HIV-1 disease (CD4 lymphocyte count = 64 cells per cmm) died of pulmonary hemorrhage approximately 2 weeks following acute onset of a febrile illness characterized by pancytopenia, particularly rapidly progressive thrombocytopenia, and elevated hepatic aminotransferase levels. Intracytoplasmic ehrlichial morulae were identified within mononuclear cells from a bone marrow biopsy obtained shortly prior to death.At autopsy, ehrlichiae were identified by electron microscopy within bone marrow leukocytes and by an immunoperoxidase stain for Ehrlichia in leukocytes of the bone marrow, lung, spleen and lymph nodes. Distinct histopathological lesions included depletion and destruction of periarteriolar splenic lymphocytes with replacement by nodular histiocytic aggregates; focal lymph node necrosis; hemophagocytosis of erythrocytes in the bone marrow; and extensive alveolar hemorrhage within the lungs. Polymerase chain reaction techniques using probes to the 16S rRNA gene of E. chaffeensis revealed E. chaffeensis DNA in a sample of the patient's blood, although an antibody titer to Ehrlichia was absent by indirect fluorescent antibody testing. Given the potential for absence of a diagnostic serologic response, a high index of suspicion for human ehrlichiosis should be maintained in HIV-1 patients from endemic areas of E. chaffeensis who present acutely with fever and hematologic cytopenias.
Abstr Gen Meet Am Soc Microbiol. 1993; 93: 110 (abstract no. D-87).
"I shall pass this way but once, therefore any kindness I can show or any help I can give, let me do it now, for I shall not pass this way again."- Author Unknown
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