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She was treated with ceftriaxone and azithromycin for possible community-acquired pneumonia but declining mental status necessitated intensive care unit transfer. Vancomycin and doxycycline were added. Her course was complicated by seizures requiring antiepileptic therapy. Peripheral blood smear demonstrated morulae in monocytes. Serum <jats:italic>Ehrlichia chaffeensis<\/jats:italic> DNA was positive confirming the diagnosis of human monocytic ehrlichiosis. She recovered without residual neurological deficits after 10\u2005days of doxycycline therapy.<\/jats:p>","DOI":"10.1136\/bcr-2016-215967","type":"journal-article","created":{"date-parts":[[2016,10,6]],"date-time":"2016-10-06T18:52:59Z","timestamp":1475779979000},"page":"bcr2016215967","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Severe human monocytic ehrlichiosis presenting with altered mental status and seizures"],"prefix":"10.1136","volume":"2016","author":[{"given":"Christian","family":"Geier","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington DC, 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