Ehrlichia-induced hemophagocytic lymphohistiocytosis in a pediatric kidney transplant recipient

• Published in: Pediatric transplantation Vol. 26; no. 1; p. e14134
• Main Authors: Singh, Nisha S, Pagano, Alexa L, Hays, Allyson J, Kats, Alexander, Dahl, Steven M, Warady, Bradley A, Beins, Nathan T, Yin, Dwight E
• Format: Report
• Language: English
• Published: 01.02.2022
• ISSN: 1399-3046
• DOI: 10.1111/petr.14134

BACKGROUNDKidney transplant patients are susceptible to a variety of infections in the post-transplant period due to the use of immunosuppressant medications. Ehrlichiosis is a rare infection in solid organ transplant recipients with signs and symptoms that mimic rejection and other viral infections. Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyperinflammatory syndrome that can be triggered by infections. METHODSWe describe a pediatric kidney transplant recipient who experienced secondary HLH due to ehrlichiosis within the initial post-transplant month. RESULTOur patient improved after treatment with doxycycline, corticosteroids, and intravenous immunoglobulin (IVIG). CONCLUSIONClinicians should consider infections such as ehrlichiosis as a potential cause of illness in febrile solid organ transplant recipients in immediate post-transplant period, especially when accompanied by a compatible exposure history.