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Erythema migrans caused by Borrelia afzelii in Slovenia and erythema migrans caused by B. burgdorferi in New York have distinct clinical presentations. Caution should be used when clinical and labo...

Human granulocytic ehrlichiosis (HGE) is a newly described illness with few reports in the literature.To describe the clinical and laboratory feature of HGE.Case series.Tertiary care facility in New York State.18 adult patients with HGE.Epidemiologic, clinical, and laboratory features; treatment; and outcome of patients with HGE.Patients presented with such symptoms as fever (94%) and myalgia or arthralgia (78%). Thirteen patients (71%) recalled being bitten by a tick before onset of symptoms. Leukopenia or thrombocytopenia was seen in 82% of patients, and abnormal liver enzyme levels were seen in 81%. Results of polymerase chain reaction were positive in 9 of 12 patients (75%); morulae were seen in 3 of 12 patients (25%); and the agent that causes HGE was cultured from 2 patients. All but one patient (94%) developed antibodies to Ehrlichia equi. Five patients (28%) were briefly hospitalized, and none died. All patients were successfully treated with doxycycline.The illness associated with HGE in these patients from the northeastern United States was more mild than that originally described in reports of HGE in the midwestern United States.