Ehrlichiosis presenting as severe sepsis and meningoencephalitis in an immunocompetent adult.
Introduction: Ehrlichia are obligate intracellular pathogens transmitted to vertebrates by ticks.
Case presentation: We report the case of a 59-year-old man who presented to the University of Kentucky Albert B. Chandler Medical Center (Lexington, KY, USA) after being found fallen down in the woods. A lumbar puncture revealed what appeared to be bacterial meningitis, yet cerebrospinal fluid cultures, Gram stains and a meningitis/encephalitis panel were inconclusive. However, an Ehrlichia DNA PCR of the blood resulted as being positive for Ehrlichia chaffeensis antibodies. The patient received a 14 day course of doxycycline, and recovered from his multiple organ failure. The aetiology of the ehrlichial meningoencephalitis was likely transmission through a tick-bite, due to the patient’s outdoor exposure.
Conclusion: While it is rare to see Ehrlichia as a cause of meningitis, this illness can progress to severe multisystem disease with septic shock, meningoencephalitis or acute respiratory distress syndrome (ARDS). Those with compromised immunity are at a higher risk of developing the more severe form of the disease and have higher case fatality rates.
Nothing about this monster is rare – it’s just not in the literature yet. Again, researchers would be wise to remember that just because something isn’t found in the literature, doesn’t mean it doesn’t happen, particularly in a disease complex that testing misses half the cases and much goes unreported because it’s undiagnosed or misdiagnosed.
Notice this poor man was found flat on his face in the woods – that’s how serious this stuff can be. Please notice his immune system was fine.
Meningeal involvement (brain swelling) is NOT rare. Why would it be? When these pathogens can cross the blood/brain barrier, it makes complete, logical sense that people would deal with swelling. They deal with swelling in their elbows, knees, fingers, wrists, and about every other place in the body. Dr. Phillips talks about Balanitus, a painful swelling of the foreskin, or head of the penis in males here: https://madisonarealymesupportgroup.com/2018/12/22/s-e-x-lyme-msids/
I had swelling in my head so great that I wondered if I’d ever go a day without excruciating headaches that honestly felt like I’d been kicked by a horse, but the pain was completely all over in the lining of my head (meningeal). I had an MRI, which came back normal, but I’ve met numerous folks with a Lyme and Chiari diagnosis: https://madisonarealymesupportgroup.com/2016/04/02/chiari/
Warning – some with Lyme/MSIDS go through with the Chiari surgery but continue to have symptoms because until the pathogens are dealt with, symptoms will not resolve.