SHM Converge Scientific Abstract ePoster Gallery-An Atypical Case of Babesiosis Masquerading as Microangiopathic Hemolytic Anemia

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This case report describes a 70-year-old man with anti-PLA2R membranous nephropathy who presented with acute progressive dyspnea and pallor and was initially thought to have thrombotic thrombocytopenic purpura (TTP) because of thrombocytopenia, hemolysis, and a peripheral smear showing only one schistocyte. He was treated with plasma exchange and prednisone, but his platelet count continued to fall over 9 days. When ADAMTS13 testing returned normal, atypical hemolytic uremic syndrome (aHUS) was considered and eculizumab was started. The next day he developed fever, prompting repeat review of the blood smear, which revealed Babesia parasitemia. He was then diagnosed with babesiosis and treated for 17 days with azithromycin 500 mg daily and atovaquone 750 mg twice daily, after which his hemoglobin and platelet counts normalized.<br /><br />The report emphasizes that babesiosis can rarely present with microangiopathic hemolytic anemia and may mimic TTP or aHUS. It also highlights that an initial peripheral smear can miss Babesia organisms, so repeated smear examination by an experienced provider is important when the diagnosis remains uncertain or when empiric treatment is ineffective.<br /><br />The discussion outlines possible mechanisms of Babesia-related hemolysis and thrombocytopenia, including erythrocyte invasion and rupture, oxidative damage, phosphatidylserine exposure, and immune-mediated platelet destruction. Overall, the case underscores the need to consider babesiosis in the differential diagnosis of microangiopathic hemolytic anemia in the appropriate clinical setting.

Asset Subtitle

Lane E. Andrews

Meta Tag

Author List Lane E. Andrews, Maxwell Bressman MD

Category Clinical Vignettes

Concept Babesiosis

Concept Microangiopathic Hemolytic Anemia

Concept Peripheral Blood Smear

Concept Azithromycin

Concept Atovaquone

Distinguished Non-Finalist

Presenter Organization Greenwich Hospital - Yale New Haven Health

Presenting Author Lane E. Andrews

Track Adult

Keywords

babesiosis

microangiopathic hemolytic anemia

thrombotic thrombocytopenic purpura

atypical hemolytic uremic syndrome

ADAMTS13

eculizumab

Babesia parasitemia

peripheral blood smear

hemolysis

thrombocytopenia

Babesiosis

Microangiopathic Hemolytic Anemia

Peripheral Blood Smear

Azithromycin

Atovaquone