Pulmonary hypertension with severe sepsis in ehrlichiosis: what you should know before you hike

Ehrlichiosis is a tickborne illness that can lead to an increased risk of death without appropriate treatment. According to Centers for Disease Control and Prevention, there has been a rise in incidence. We present a case of an immunocompetent patient who reported tick removal after hiking. Chest imaging showed pulmonary vascular congestion, extensive bilateral airspace and bibasilar moderate-dependent pleural effusions. Transthoracic echocardiography showed moderate pulmonary hypertension with right ventricular systolic pressure of 56.3 mm Hg. <i>Ehrlichia chaffeensis</i> PCR testing came back positive. Doxycycline was started in the emergency department and continued for 14 days. The patient had a resolution of the pulmonary hypertension and decrease in tricuspid regurgitation. However, mild mitral regurgitation was persistent. The pulmonary hypertension may be caused by the patient's response to ehrlichiosis infection, but it may also be explained by the development of acute respiratory distress syndrome, which has been documented in multiple studies.