Granulomatosis with Polyangiitis Occurring Concurrently With Human Monocytic Ehrlichiosis, a Causative Relationship or Coincidence

Edward Charbek^1, , Rajaa AlMourani², Rugheed Ghadban³ and David A. Stoeckel⁴

¹Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri 63110, USA

²Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri 63110, USA

³Department of Internal Medicine, VA medical Center, John Cochran Division, St. Louis, Missouri 63106, USA

⁴Division of Pulmonary and Critical care Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri 63110, USA

Cite this paper

Edward Charbek, Rajaa AlMourani, Rugheed Ghadban and David A. Stoeckel. Granulomatosis with Polyangiitis Occurring Concurrently With Human Monocytic Ehrlichiosis, a Causative Relationship or Coincidence. American Journal of Medical Case Reports. 2016; 4(8):258-260. doi: 10.12691/AJMCR-4-8-2

Abstract

The relationship between some infections and vasculitides especially antineutrophil cytoplasmic antibodies (ANCA) mediated disease is well established. However, the mechanisms by which infection triggers ANCA formation are not fully understood. We report a case of granulomatosis with polyangiitis (GPA) occurring concurrently with human monocytic ehrlichiosis (HME) and discuss the possible relation between the two disease processes. A 49 year old Caucasian female presented with septic shock with multiple organ dysfunction syndrome that was attributed to HME. The patient was noted to have a small crusted lesion on the left nasolabial fold. Over the course of her hospitalization, it gradually expanded and eroded into the nasal cavity. After appropriate workup, she was diagnosed with GPA. HME hasn’t been clearly linked to any type of vasculitis. Review of the literature revealed scarce evidence limited to case reports and retrospective studies describing the association between GPA and HME. We highlight in this case a possible link between HME and GPA, however, the exact relationship between HME and GPA remains unclear and warrants further study.

Keywords

granulomatosis with polyangiitis, human monocytic ehrlichiosis, vasculitis

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Chen M, Min C, Kallenberg CGM. The environment, geoepidemiology and ANCAassociated vasculitides. Autoimmun Rev. 2010;9: A293-A298.
[2]	Stone JH, Dierberg K, Aram G, Dumler JS. Human monocytic ehrlichiosis. JAMA. 2004; 292: 2263-2270.
[3]	Olano JP, Walker DH. Human ehrlichioses. Med Clin North Am. 2002;86: 375-392.
[4]	Walker DH, Dumler JS. Human monocytic and granulocytic ehrlichioses. Discovery and diagnosis of emerging tickborne infections and the critical role of the pathologist. Arch Pathol Lab Med. 1997;121: 785-791.
[5]	Falk RJ, Gross WL, Guillevin L, Hoffman G, Jayne DRW, Jennette JC, et al. Granulomatosis with polyangiitis (Wegener’s): an alternative name for Wegener's granulomatosis. Ann Rheum Dis. 2011;70: 704.
[6]	Stegeman CA, Tervaert JW, Sluiter WJ, Manson WL, de Jong PE, Kallenberg CG. Association of chronic nasal carriage of Staphylococcus aureus and higher relapse rates in Wegener granulomatosis. Ann Intern Med. 1994;120: 12-17.
[7]	Finkel TH, Török TJ, Ferguson PJ, Durigon EL, Zaki SR, Leung DY, et al. Chronic parvovirus B19 infection and systemic necrotising vasculitis: opportunistic infection or aetiological agent? Lancet. 1994;343: 1255-1258.
[8]	Gibb W, William G, Anthony W. Nocardiosis mimicking Wegener’s granulomatosis. Scand J Infect Dis. 1986;18: 583-585.
[9]	Heal JR, Roberts GW, Raynes JG, Ashish B, Miller AD. Specific Interactions Between Sense and Complementary Peptides: The Basis for the Proteomic Code. Chembiochem. 2002;3: 136-151.
[10]	Brinkmann V. Neutrophil Extracellular Traps Kill Bacteria. Science. 2004;303: 1532-1535.
[11]	Barnado A, Crofford LJ, Oates JC. At the Bedside: Neutrophil extracellular traps (NETs) as targets for biomarkers and therapies in autoimmune diseases. J Leukoc Biol. 2016;99: 265-278.
[12]	Pick N, Potasman I, Strenger C, Keysary A, Schwartz I. Ehrlichiosis associated vasculitis. J Intern Med. 2000; 247: 674-678.
[13]	Paddock CD, Childs JE. Ehrlichia chaffeensis: a prototypical emerging pathogen. Clin Microbiol Rev. 2003;16: 37-64.