Ehrlichia‐induced hemophagocytic lymphohistiocytosis in a pediatric kidney transplant recipient

Abstract

Fever in a kidney transplant recipient can be due to a variety of infections in the post-transplant period. Infection in the first month after solid organ transplant is primarily due to nosocomial bacterial or candidal infections and donor-derived infections. Opportunistic infections including viruses (Epstein-Barr virus [EBV], cytomegalovirus [CMV], and parvovirus), fungi, and Pneumocystis jiroveci are more common after the first post-transplant month. 1 Zoonotic infections, such as ehrlichiosis, are an uncommon cause of acute febrile illness in the immediate post-transplant period. Ehrlichiosis is a tick-borne illness caused by three genera: Ehrlichia, Anaplasma, and Neoehrlichia. 2,3 Ehrlichia chaffeensis is an obligate intracellular bacterium that infects monocytes and causes human monocytotropic ehrlichiosis (HME) and is transmitted by the bite of the lone star tick (Amblyomma americanum). HME occurs predominantly in the southcentral and southeastern United States 3 and demonstrates seasonal variability, with the majority of cases