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A 56-year-old man with a history of Wegener granulomatosis presented with 6 days of sinus congestion, fever, malaise, myalgias, episcleritis, and a morbilli form rash. An exacerbation of Wegener granulomatosis was the principal concern because of the frequency of flares in that disease. The patient developed acute r enal failure, thrombocytopenia, transaminitis, and, finally, severe myocarditis that led to congestive heart failure. Additional history-taking and the evoluti on of his clinical features led to empirical treatment with doxycycline for huma n monocytic ehrlichiosis(HME). The diagnosis of HME was confirmed by both a poly merase chain reaction assay for Ehrlichia chaffeensis and by the demonstration of morulae within peripheral blood mononuclear cells. The patient improved prompt ly followinginstitution of doxycycline, and his cardiac function returned to nor mal over a period of 4 months.
A 56-year-old man with a history of Wegener granulomatosis presented with 6 days of sinus congestion, fever, malaise, myalgias, episcleritis, and a morbilli form rash. An exacerbation of Wegener granulomatosis was the principal concern because of the frequency of flares in that disease. The patient developed acute r enal failure, thrombocytopenia, transaminitis, and, finally, severe myocarditis that led to congestive heart failure. Additional history-taking and the evoluti on of his clinical features led to empirical treatment with doxycycline for huma n The diagnosis of HME was confirmed by both a poly merase chain reaction assay for Ehrlichia chaffeensis and by the demonstration of morulae within peripheral blood mononuclear cells. The patient improved prompt ly followinginstitution of doxycycline, and his cardiac function returned to nor mal over a period of 4 months.