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| Item Type: | Article |
|---|---|
| Title: | Neoehrlichiosis associated with arteriovenous fistula thrombosis: a case report |
| Creators: |
Meckenstock, Laura Charlotte, Wackernagel, Lisa-Marie, Fingerle, Volker, Schwarzer, Rolf, Graf, Barbara, Jochens, Hans, Szijártó, Istvan Andras  ORCID: https://orcid.org/0000-0002-0796-9450, Eckardt, Kai-Uwe, Wilck, Nicola ORCID: https://orcid.org/0000-0003-3189-5364, Enghard, Philipp and Ostendorf, Lennard ORCID: https://orcid.org/0000-0003-3553-6406
|
| Abstract: | We report a case of a 55-year-old female with therapy-refractory myasthenia gravis receiving immunosuppressive treatment, including rituximab, as well as weekly plasma exchange via a stented brachiocephalic arteriovenous fistula. She presented with recurrent thromboses and central stenoses of her arteriovenous fistula, as well as recurrent fever, shivering, malaise, and a localized skin rash. Blood cultures, serological testing, and untargeted next-generation sequencing (NGS) for common pathogens were negative. Histopathology of a skin biopsy demonstrated partial small-vessel thrombosis but no evidence of an infectious agent. PET-CT revealed increased metabolic activity around the implanted stent, raising concern for stent infection. During a subsequent percutaneous transluminal angioplasty, blood was sampled directly from the affected fistula segment after dilatation, and 16S rRNA gene PCR with amplicon NGS demonstrated the presence of Neoehrlichia mikurensis. Antimicrobial therapy with rifampicin was initiated for six weeks. Clinical and laboratory indicators of infection normalized, and follow-up PET-CT demonstrated resolution of the previously increased metabolic activity. Neoehrlichiosis is an emerging tick-borne disease prevalent in Eurasia. Clinical manifestations of neoehrlichiosis include fever, myalgia, arthralgia, thrombotic events and cutaneous lesions, and are most frequently observed in immunocompromised individuals. As this intracellular bacterium is detectable only through molecular methods, the infection is likely underrecognized. Our case demonstrates that neoehrlichiosis should be considered in immunosuppressed patients presenting with fever and vascular access complications. A high index of clinical suspicion is required, as untargeted NGS from peripheral blood may fail to detect the pathogen, whereas local sampling can increase the likelihood of diagnosis. |
| Keywords: | Neoehrlichiosis, Neoehrlichia Mikurensis, Fever of Unknown Origin, Arteriovenous Fistula Thrombosis |
| Source: | Kidney International Case Reports |
| ISSN: | 3117-471X |
| Publisher: | Elsevier |
| Page Range: | 100123 |
| Number of Pages: | 1 |
| Date: | 26 August 2026 |
| Official Publication: | https://doi.org/10.1016/j.kintcr.2026.100123 |
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