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Neoehrlichia mikurensis Causing Thrombosis and Relapsing Fever in a Lymphoma Patient Receiving Rituximab

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 patient...

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Autores principales: Sjöwall, Johanna, Kling, Kristian, Ochoa-Figueroa, Miguel, Zachrisson, Helene, Wennerås, Christine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537581/
https://www.ncbi.nlm.nih.gov/pubmed/34683459
http://dx.doi.org/10.3390/microorganisms9102138
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author Sjöwall, Johanna
Kling, Kristian
Ochoa-Figueroa, Miguel
Zachrisson, Helene
Wennerås, Christine
author_facet Sjöwall, Johanna
Kling, Kristian
Ochoa-Figueroa, Miguel
Zachrisson, Helene
Wennerås, Christine
author_sort Sjöwall, Johanna
collection PubMed
description 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.
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spelling pubmed-85375812021-10-24 Neoehrlichia mikurensis Causing Thrombosis and Relapsing Fever in a Lymphoma Patient Receiving Rituximab Sjöwall, Johanna Kling, Kristian Ochoa-Figueroa, Miguel Zachrisson, Helene Wennerås, Christine Microorganisms Case Report 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. MDPI 2021-10-12 /pmc/articles/PMC8537581/ /pubmed/34683459 http://dx.doi.org/10.3390/microorganisms9102138 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Sjöwall, Johanna
Kling, Kristian
Ochoa-Figueroa, Miguel
Zachrisson, Helene
Wennerås, Christine
Neoehrlichia mikurensis Causing Thrombosis and Relapsing Fever in a Lymphoma Patient Receiving Rituximab
title Neoehrlichia mikurensis Causing Thrombosis and Relapsing Fever in a Lymphoma Patient Receiving Rituximab
title_full Neoehrlichia mikurensis Causing Thrombosis and Relapsing Fever in a Lymphoma Patient Receiving Rituximab
title_fullStr Neoehrlichia mikurensis Causing Thrombosis and Relapsing Fever in a Lymphoma Patient Receiving Rituximab
title_full_unstemmed Neoehrlichia mikurensis Causing Thrombosis and Relapsing Fever in a Lymphoma Patient Receiving Rituximab
title_short Neoehrlichia mikurensis Causing Thrombosis and Relapsing Fever in a Lymphoma Patient Receiving Rituximab
title_sort neoehrlichia mikurensis causing thrombosis and relapsing fever in a lymphoma patient receiving rituximab
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537581/
https://www.ncbi.nlm.nih.gov/pubmed/34683459
http://dx.doi.org/10.3390/microorganisms9102138
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