A case of Ehrlichiosis mimicking course of thrombotic thrombocytopenic purpura requiring hemodialysis
Bibliographic record
Abstract
We present an atypical presentation of Ehrlichiosis induced sepsis requiring hemodialysis. Ehrlichiosis is a common tick‐borne illness in Missouri, and in this case mimicks the course of thrombotic thrombocytopenic purpura (TTP). A 48‐year‐old male with a history of marginal zone lymphoma had received radiation and chemotherapy with fludarabine. He was admitted to oncology service for evaluation of nausea and vomiting and generalized malaise. His initial laboratory data revealed platelet count 16,000 mm3, WBC 3,800 mm3, AST 327 units/L, ALT 185 units/L, BUN/Creatinine 53 mg/dl/3.8 mg/dl. Because the peripheral smear showed a morulae consistent with human granulocytic Ehrlichiosis, intravenous doxycycline 100 mg twice daily was initiated. Acute renal failure was thought due to hemodynamic changes, but the role of TTP remained in the differential diagnosis. On hospital day two, he became confused and lethargic and continued to be febrile. Hours later, he developed tonic‐clonic seizures and became hypotensive. A clinical diagnosis of TTP was made. Peripheral smear showed only a few schistocytes, inconsistent with TTP. Microangiaopthic anemia, thrombocytopenia, sepsis with DIC, and multi‐organ failure sustained the acute renal failure. Hemodialysis was used for ARF over the next several days in conjuction with IV doxycycline. The patient improved without plasmapharesis. Kidney function returned back to normal in due course of time. A final diagnosis of ehrlichia‐induced sepsis with ARF was made. Conclusion: Ehrlichiosis is endemic in Missouri and usually presents with thrombocytopenia, leukopenia, and elevated liver function tests; however it rarely presents with sepsis. The course of this case was made unusual possibly due to chemotherapy, fludarabine for the treatment of lymphoma, which can commonly cause micrangiopathic anemia, myelosuppression, and even a leukopenia for several years afterwards. This presentation mimicking TTP can be confusing but has previously been documented as a complication of severe Ehrlichiosis in the immunocompromised state.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".