{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:19:59Z","timestamp":1788441599158,"version":"build-2803163510"},"reference-count":10,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>\n                    Ehrlichiosis is a rare tick-borne zoonosis caused by\n                    <jats:italic>Ehrlichia chaffeensis<\/jats:italic>\n                    ,\n                    <jats:italic>E. ewingii<\/jats:italic>\n                    and related species. In solid organ transplant recipients, immunosuppression can result in atypical presentations, delayed diagnosis and poor outcomes. The disease remains under-recognised among lung transplant recipients despite its potentially fatal course. A man in his early 70s with a history of bilateral lung transplantation for chronic obstructive pulmonary disease presented with a high-grade fever and shortness of breath. Bronchoalveolar lavage (BAL) culture grew\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    and meropenem was initiated. He subsequently developed severe thrombocytopenia, acute kidney injury and elevated liver transaminases. Disseminated intravascular coagulation (DIC) and thrombotic thrombocytopenic purpura (TTP) were excluded, while haemophagocytic lymphohistiocytosis (HLH) was considered but not confirmed. His condition rapidly progressed to multiorgan failure requiring mechanical ventilation and haemodialysis.\n                    <jats:italic>E. chaffeensis<\/jats:italic>\n                    was identified postmortem by next-generation sequencing. This case highlights diagnostic challenges and the importance of early empiric doxycycline therapy in endemic areas.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2026-272182","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T13:27:01Z","timestamp":1782912421000},"page":"e272182","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Beware the tick: ehrlichiosis in a lung transplant recipient"],"prefix":"10.1136","volume":"19","author":[{"given":"Sadik Canturk","family":"Balci","sequence":"first","affiliation":[{"name":"Division of Lung Transplantation, Mayo Clinic, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafsa","family":"Fayyaz","sequence":"additional","affiliation":[{"name":"Division of Lung Transplantation, Mayo Clinic, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragini","family":"Gopagoni","sequence":"additional","affiliation":[{"name":"Division of Lung Transplantation, Mayo Clinic, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8313-6015","authenticated-orcid":false,"given":"Remzi","family":"Bag","sequence":"additional","affiliation":[{"name":"Division of Lung Transplantation, Mayo Clinic, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"2026090306051017000_19.7.e272182.1","doi-asserted-by":"publisher","DOI":"10.3201\/eid0803.010249"},{"key":"2026090306051017000_19.7.e272182.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2007.01821.x"},{"key":"2026090306051017000_19.7.e272182.3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.bcmd.2019.03.002","article-title":"Human ehrlichiosis at a tertiary-care academic medical center: Clinical associations and outcomes of transplant patients and patients with hemophagocytic lymphohistiocytosis","volume":"77","author":"Otrock","year":"2019","journal-title":"Blood Cells Mol Dis"},{"key":"2026090306051017000_19.7.e272182.4","doi-asserted-by":"crossref","DOI":"10.1111\/tid.12652","article-title":"Early diagnosis of Ehrlichia ewingii infection in a lung transplant recipient by peripheral blood smear","volume":"19","author":"Regunath","year":"2017","journal-title":"Transpl Infect Dis"},{"key":"2026090306051017000_19.7.e272182.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3062.2009.00373.x"},{"key":"2026090306051017000_19.7.e272182.6","doi-asserted-by":"crossref","first-page":"116484","DOI":"10.1016\/j.diagmicrobio.2024.116484","article-title":"Ehrlichiosis and anaplasmosis in solid organ transplantation: A case series and review of the literature","volume":"110","author":"Jang","year":"2024","journal-title":"Diagn Microbiol Infect Dis"},{"key":"2026090306051017000_19.7.e272182.7","first-page":"1292","article-title":"Donor-derived ehrlichiosis: two clusters following solid organ transplantation","volume":"74","author":"Mowla","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2026090306051017000_19.7.e272182.8","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr6501e1"},{"key":"2026090306051017000_19.7.e272182.9","first-page":"1414","article-title":"Two fatal cases of novel Ehrlichia species infection in solid organ transplant recipients","volume":"17","author":"Pritt","year":"2011","journal-title":"Emerg Infect Dis"},{"key":"2026090306051017000_19.7.e272182.10","doi-asserted-by":"crossref","first-page":"A6341","DOI":"10.1016\/j.chest.2024.06.3758","article-title":"HLH SECONDARY TO EHRLICHIOSIS IN A LUNG TRANSPLANT RECIPIENT","volume":"166","author":"Kretschmar","year":"2024","journal-title":"Chest"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272182","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:05:19Z","timestamp":1788440719000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272182"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":10,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,1]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bcr-2026-272182"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272182","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}