Infectious Disease · Internal Medicine · 4 h ago
Tickborne N. mikurensis infection caused recurrent fever in a Dutch lymphoma patient
A case report describes a 69-year-old man receiving immunochemotherapy for non-Hodgkin lymphoma who had recurrent fever and systemic inflammatory episodes over about a year. Broad-range and organism-specific PCR identified Neoehrlichia mikurensis; symptoms resolved after doxycycline treatment.
- Recurrent fever occurred during lymphoma immunochemotherapy.
- Blood PCR identified N. mikurensis after routine tests were unrevealing.
- Fever and edema subsided after three weeks of doxycycline.
- Single early-release case; specialized PCR was required.
A 69-year-old man in the Netherlands receiving R-CVP immunochemotherapy for indolent non-Hodgkin lymphoma was admitted repeatedly with fever, chills, night sweats, leg edema and episodes of systemic inflammatory response. Routine investigations, including blood cultures, did not identify a cause, and empirical cefuroxime did not produce a sustained response. The patient reported hiking in a national park but initially did not report a tick bite.
Broad-range bacterial 16S rRNA PCR followed by sequencing detected N. mikurensis DNA, and a specific blood PCR confirmed the diagnosis. After a three-week course of doxycycline, fever and edema subsided within days. Blood PCR tests at three and six months were negative.
The report highlights N. mikurensis as a possible cause of recurrent fever in immunocompromised patients in tick-endemic areas, including those receiving B-cell-depleting therapy. Diagnosis may require specialized PCR testing. This is a single case and cannot establish how often the infection occurs or how broadly its findings apply. The article is an early-release publication, and the authors note that further prospective studies are needed.
In practice
In tick-exposed areas, clinicians evaluating recurrent fever in immunocompromised patients may consider N. mikurensis, particularly when routine investigations are unrevealing; this case involved a patient receiving lymphoma immunochemotherapy and was confirmed using broad-range and specific PCR. Symptoms resolved after a three-week doxycycline course, with subsequent blood PCR tests negative. However, this is a single case, and testing may be limited to laboratories with appropriate resources. It does not establish prevalence or justify changing treatment practice on its own.
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Emerging Infectious Diseases: Neoehrlichia mikurensis Infection in Immunocompromised Patient, the Netherlands, 2024 ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.