EHRLICHIOSIS AFTER PANCREAS TRANSPLANTATION

Abstract

368 Human ehrlichioses are tick-borne infections caused by bacteria in the genus ehrlichia of the family Rickettsiaceae. Since it was first identified in 1987, two types have been found to exist; human monocytic ehrlichiosis (HME) and human granulocytic ehrlichiosis (HGE). To date there have been two cases of ehrlichiosis in the transplant population, an HME infection in a liver transplant patient and a case of HGE in a kidney recipient. We report herein three pancreas transplant patients who developed HGE post transplant within the last two years at a Southeastern center (Table).TableDespite uniform symptomatology none of the patients had another source of infection and bone marrow biopsies in each case revealed HGE. All three patients were treated with doxycycline for two weeks, filgrastim and a reduction in immunosuppression. Two patients experienced complete recovery. One patient (Pt#3) expired secondary to development of a secondary opportunistic infection with toxoplasmosis. Conclusion: In the setting of potent immunosuppression, ehrlichiosis should be included in the differential diagnosis when transplant patients present with persistent fever, pancytopenia, and abnormal liver function. Ehrlichiosis patients may be at risk of developing greater opportunistic or lymphoproliferative disease.