Myocarditis Secondary to Human Monocytotrophic Ehrlichiosis

Ehrlichiosis is a tick-borne illness that has been recognized as a source of human infection with increased incidence in the United States over the last decade. The usual presentation is with acute febrile illness, myalgia, malaise with confusion, and central nervous system abnormalities, along with laboratory data concerning transaminitis and hematological abnormalities. Though many complications have been associated with Ehrlichiosis, very few cardiac complications have been reported. We report a rare presentation of Ehrlichiosis in a 63-year-old female who presented with acute fever, transaminitis, and renal failure followed by the development of myocarditis. As part of the diagnostic work-up, an examination of the peripheral smear revealed intracytoplasmic granules in monocytes, which were later confirmed through serology to have Ehrlichia chaffeensis (E. chaffeensis). Given the high degree of initial clinical suspicion, the patient was started on empiric doxycycline and fully recovered with no disease-associated sequelae.