1. Neoehrlichia mikurensis Causing Thrombosis and Relapsing Fever in a Lymphoma Patient Receiving Rituximab
- Author
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Kristian Kling, Johanna Sjöwall, Miguel A. Ochoa-Figueroa, Christine Wennerås, and Helene Zachrisson
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,relapsing fever ,QH301-705.5 ,Neoehrlichia mikurensis ,medicine.medical_treatment ,Splenectomy ,tick-borne disease ,Case Report ,Disease ,Malignancy ,Microbiology ,splenectomy ,rituximab ,Virology ,medicine ,Blood culture ,fever ,thrombosis ,malignant lymphoma ,Biology (General) ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Thrombosis ,Dermatology ,Lymphoma ,Mikrobiologi ,Rituximab ,business ,medicine.drug - Abstract
Neoehrlichia (N.) mikurensis, an intracellular tick-borne bacterium not detected by routine blood culture, is prevalent in ticks in Scandinavia, Central Europe and Northern Asia, and may cause long-standing fever, nightly sweats, migrating pain, skin rashes and thromboembolism, especially in patients treated with rituximab. The multiple symptoms may raise suspicion of both infection, inflammation and malignancy, and lead in most cases to extensive medical investigations across many medical specialist areas and a delay of diagnosis. We describe a complex, albeit typical, case of neoehrlichiosis in a middle-aged splenectomised male patient with a malignant lymphoma, receiving treatment with rituximab. The multifaceted clinical picture associated with this tick-borne disease is addressed, and longitudinal clinical and laboratory data, as well as imaging, are provided. Longstanding relapsing fever in combination with thrombosis in superficial and deep veins in an immunocompromised patient living in a tick-endemic region should raise the suspicion of the emerging tick-borne disease neoehrlichiosis. Given the varied clinical presentation and the risk of delay in diagnosis and treatment, we believe it is important to raise clinicians awareness of this emerging infection, which is successfully treated with doxycycline. Funding Agencies|Region Ostergoetland (ALF grants); Swedish government; Region Vaestra GoetalandRegion Auvergne-Rhone-AlpesRegion Bourgogne-Franche-ComteRegion Hauts-de-FranceRegion Nouvelle-Aquitaine [ALFGBG-722141]; North Sea Programme of the European Regional Development Fund of the European Union (NorthTick); Swedish Research CouncilSwedish Research CouncilEuropean Commission [2020-01287]
- Published
- 2021