# Ehrlichiosis Manifesting as Septic Shock and Respiratory Failure With Alveolar Hemorrhage in an Immunocompetent Patient

## TL;DR

A 75-year-old woman developed severe ehrlichiosis with septic shock and lung bleeding after a tick bite, highlighting the need for early diagnosis.

## Contribution

This case highlights alveolar hemorrhage as a rare but serious complication of ehrlichiosis in an immunocompetent patient.

## Key findings

- Ehrlichiosis can progress to severe disease with septic shock and alveolar hemorrhage.
- Molecular testing confirmed the diagnosis, and treatment with doxycycline led to clinical improvement.
- Early recognition and treatment are crucial for better outcomes in ehrlichiosis.

## Abstract

Ehrlichiosis is a bacterial infection transmitted through the bite of an infected lone star tick. The disease presents as a flu-like illness that is typically mild and self-limited. However, it can progress to severe disease with multiorgan involvement and numerous complications. We present a case of a 75-year-old immunocompetent female patient who developed septic shock and respiratory failure with alveolar hemorrhage after tick exposure. She was diagnosed with ehrlichiosis based on molecular testing via polymerase chain reaction (PCR) and completed a 10-day course of doxycycline with clinical improvement. Alveolar hemorrhage is a rare but serious complication of ehrlichiosis. This case emphasizes the importance of detailed history taking and the value of pattern recognition to facilitate timely diagnosis and treatment of ehrlichiosis, which is necessary for improved patient outcomes.