SHM Converge Scientific Abstract ePoster Gallery-A Rare Presentation of Fever and Pancytopenia in Northern Arizona

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This case describes a 70-year-old woman in Northern Arizona who developed fever, chills, night sweats, weight loss, malaise, pancytopenia, hepatosplenomegaly, and a rash after recent travel to Massachusetts and Vermont, areas endemic for babesiosis. Initial evaluation showed anemia, leukopenia, severe thrombocytopenia, elevated liver enzymes, and splenic infarcts on CT. Because of the fever and possible tick exposure, she was started on empiric doxycycline for a suspected tick-borne illness.<br /><br />Her condition worsened over the next few days, with rising concern for hemophagocytic lymphohistiocytosis (HLH) due to pancytopenia and markedly elevated ferritin (4335), giving an H-score of 175, which suggested a substantial probability of HLH. Peripheral blood smear revealed intraerythrocytic and extracellular ring-form organisms, and Babesia microti PCR returned positive. Other infectious studies, including blood cultures, EBV, CMV, hepatitis testing, malaria PCR, and other tick-borne panels, were negative.<br /><br />Treatment was changed from doxycycline to azithromycin and atovaquone. Further workup supported the diagnosis of severe babesiosis with associated hemophagocytosis: bone marrow biopsy showed histiocytes containing red blood cells and platelets, consistent with hemophagocytosis. The patient improved clinically, and one month after discharge had complete symptom resolution and near-normal laboratory values.<br /><br />The report highlights babesiosis as a potentially severe tick-borne infection that can rarely trigger HLH, a life-threatening hyperinflammatory syndrome. It emphasizes the importance of considering babesiosis in patients with fever, pancytopenia, and recent travel to endemic regions, even in patients presenting outside those areas. This appears to be the first reported case of babesiosis complicated by HLH in Arizona.

Asset Subtitle

Tro Sekayan

Meta Tag

Author List Neeraj Vij, Samer Hasson, Tro Sekayan, Zachary Hanafi

Category Clinical Vignettes

Concept Babesiosis

Concept Hemophagocytic Lymphohistiocytosis

Concept Babesia microti

Concept Intraerythrocytic organism

Concept Anti-babesia therapy

Distinguished Non-Finalist

Presenter Organization Midwestern University - Verde Valley Medical Center

Presenting Author Tro Sekayan

Track Adult

Keywords

babesiosis

hemophagocytic lymphohistiocytosis

HLH

Babesia microti

pancytopenia

tick-borne illness

atovaquone

azithromycin

hepatosplenomegaly

Arizona

Babesiosis

Hemophagocytic Lymphohistiocytosis

Babesia microti

Intraerythrocytic organism

Anti-babesia therapy