SHM Converge Scientific Abstract ePoster Gallery-An Unusual Presentation of Hemophagocytic Lymphohistiocytosis; Immunocompetent People Not Spared!

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This case report describes an unusual presentation of hemophagocytic lymphohistiocytosis (HLH) caused by babesiosis with Lyme disease co-infection in an immunocompetent 46-year-old woman. Babesiosis is a tick-borne infection transmitted by Ixodes scapularis, and HLH secondary to babesiosis is rare, especially without immunocompromise and with Lyme co-infection.<br /><br />The patient presented with a two-day history of fever and a generalized rash that began after completing cephalexin for presumed cellulitis, initially raising concern for a drug reaction. On examination, she had a generalized erythematous maculopapular rash with diffuse petechiae. Early labs showed thrombocytopenia, elevated inflammatory markers, elevated LDH, D-dimer, and low haptoglobin. As her illness progressed, she developed worsening fevers, headache, anemia, hepatosplenomegaly, and markedly elevated ferritin and triglycerides, prompting concern for HLH.<br /><br />Extensive infectious and autoimmune workup was negative, including blood cultures, viral serologies, lumbar puncture, ANA, and other tests. She was initially treated with IV doxycycline. Later, babesiosis was confirmed by Karius testing, babesial serology, peripheral smear, and bone marrow biopsy, which also showed hemophagocytosis. Lyme serology was also positive, confirming coinfection.<br /><br />The patient improved after treatment with azithromycin and atovaquone and was discharged on oral therapy. The authors emphasize that babesiosis should be considered even without a classic exposure history, and that clinicians should avoid anchoring bias when rash and fever occur after antibiotic use, since tick-borne illness may be the true cause. The report highlights that HLH can occur in immunocompetent patients with babesiosis and Lyme coinfection.

Asset Subtitle

Syed Mujtaba Baqir

Meta Tag

Author List Diego Castellon, Kamlesh Kumar, Kelash Kumar, Larry Malkin, Mariya Astashkevich, Nureen Ahammed, Omair Khan, Sarwat Nasreen, Syed Mujtaba Baqir, Taif Al-Mansouri, Yu Shia Lin

Category Clinical Vignettes

Concept Babesiosis

Concept Hemophagocytic Lymphohistiocytosis

Concept Tick-Borne Infection

Concept Coinfection

Concept Fever

Distinguished Non-Finalist

Presenter Organization Maimonides Medical Center

Presenting Author Syed Mujtaba Baqir

Track Adult

Keywords

hemophagocytic lymphohistiocytosis

HLH

babesiosis

Lyme disease

tick-borne infection

co-infection

immunocompetent

fever and rash

hemophagocytosis

azithromycin and atovaquone

Babesiosis

Hemophagocytic Lymphohistiocytosis

Tick-Borne Infection

Coinfection

Fever