Ehrlichiosis with severe pulmonary manifestations despite early treatment

It is generally thought that if patients with ehrlichiosis are treated prom ptly, life-threatening illness can be avoided. We report a patient who soug ht medical attention 1 day after the onset of symptoms, was immediately giv en doxycycline, and still had serious illness with generalized edema, pulmo nary infiltrates, acute respiratory distress syndrome, and noncardiogenic p ulmonary edema, while receiving replacement intravenous fluids. This case a lerts physicians to the serious end of the disease spectrum that can occur even though patients are given prompt, appropriate drug treatment at the on set of illness. Further studies are needed to clearly define the mechanisms involved in pulmonary complications and generalized edema, including nonca rdiogenic pulmonary edema, in patients with ehrlichiosis.