SHM Converge Scientific Abstract ePoster Gallery-Atypical Babesia

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This case describes an unusual presentation of babesiosis in a man who developed intermittent high-grade fevers after brush clearing in the Pocono Mountains, then worsening fatigue, chills, dark urine, abdominal pain, jaundice, black stools, and delirium after travel to the Ecuadorian highlands. He had initially received ceftriaxone and cefuroxime abroad, but his symptoms progressed, leading to admission at Tisch Hospital.<br /><br />On presentation, he was febrile and tachycardic with scleral icterus, diffuse abdominal tenderness, edema, and dehydration. His course was marked by severe anemia, thrombocytopenia, transaminitis, and acute kidney injury. CT imaging showed hepatosplenomegaly and splenic infarcts. A blood smear confirmed Babesia parasitemia (1.5%), establishing the diagnosis of babesiosis. Because of concern for possible tick-borne co-infection with Borrelia, he was treated with atovaquone, azithromycin, and doxycycline, with a brief course of IV clindamycin when oral intake was poor.<br /><br />He improved clinically, parasitemia cleared, and his blood counts, liver tests, and organomegaly began resolving by follow-up in infectious disease clinic one week later.<br /><br />The case emphasizes that babesiosis can present atypically with dark urine, abdominal pain, jaundice, severe anemia, thrombocytopenia, renal injury, and even splenic complications. It also highlights the importance of obtaining a thorough travel and exposure history, since diagnosis depended on combining symptoms, laboratory findings, and environmental history.

Asset Subtitle

Tahir H. Malik

Meta Tag

Author List Alexander Chee, Luke O'Donnell, Michael Shen, Nathan Lorentz, Robert Mitrani, Tahir H. Malik

Category Clinical Vignettes

Concept Babesiosis

Concept Parasitemia

Concept Travel History

Concept Exposure History

Concept Tick Exposure

Distinguished Non-Finalist

Presenter Organization New York University, Internal Medicine

Presenting Author Tahir H. Malik

Track Adult

Keywords

babesiosis

tick-borne infection

Babesia parasitemia

splenic infarcts

hemolytic anemia

thrombocytopenia

jaundice

acute kidney injury

hepatosplenomegaly

travel history

Babesiosis

Parasitemia

Travel History

Exposure History

Tick Exposure