Fatal Seronegative Ehrlichiosis in a Patient with HIV Infection

Abstract

Human infection with Ehrlichia chaffeensis, a recently identified bacterium included in the family Rickettsiaceae,^1,2 results in an acute, generally self-limited, febrile illness associated with cytopenia and hepatic-enzyme abnormalities. Several hundred cases of E. chaffeensis infection have been recognized since 1986, although ehrlichiosis has not been described in patients infected with the human immunodeficiency virus (HIV). We report the course of a fatal seronegative ehrlichial infection in a woman with advanced HIV infection. The infection was diagnosed by light and electron microscopy, immunohistochemical techniques, and the polymerase chain reaction. The potential for successful antimicrobial treatment, combined with the possible absence of serologic markers in immunocompromised persons with HIV infection, makes this disease an important diagnostic consideration in the appropriate clinical setting.