Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA.
BMJ Case Rep. 2024 Oct 30;17(10):e260202. doi: 10.1136/bcr-2024-260202.
Ehrlichiosis is a tickborne illness that can lead to an increased risk of death without appropriate treatment. According to Centers for Disease Control and Prevention, there has been a rise in incidence. We present a case of an immunocompetent patient who reported tick removal after hiking. Chest imaging showed pulmonary vascular congestion, extensive bilateral airspace and bibasilar moderate-dependent pleural effusions. Transthoracic echocardiography showed moderate pulmonary hypertension with right ventricular systolic pressure of 56.3 mm Hg. PCR testing came back positive. Doxycycline was started in the emergency department and continued for 14 days. The patient had a resolution of the pulmonary hypertension and decrease in tricuspid regurgitation. However, mild mitral regurgitation was persistent. The pulmonary hypertension may be caused by the patient's response to ehrlichiosis infection, but it may also be explained by the development of acute respiratory distress syndrome, which has been documented in multiple studies.
埃立克体病是一种蜱传疾病，如果不进行适当治疗，可能会导致死亡风险增加。根据疾病控制和预防中心的数据，该病的发病率有所上升。我们报告了一例免疫功能正常的患者，他在徒步旅行后报告了蜱虫去除情况。胸部影像学显示肺血管充血、广泛的双侧气腔和双基底中度依赖性胸腔积液。经胸超声心动图显示中度肺动脉高压，右心室收缩压为 56.3 毫米汞柱。PCR 检测结果为阳性。在急诊科开始使用多西环素治疗，持续 14 天。患者的肺动脉高压和三尖瓣反流减少得到缓解。然而，轻度二尖瓣反流仍然存在。肺动脉高压可能是由于患者对埃立克体感染的反应引起的，但也可能是由急性呼吸窘迫综合征引起的，这在多项研究中已有记载。
