SHM Converge Scientific Abstract ePoster Gallery-Not Just Another Bite: Atraumatic Splenic Rupture Due to Babesiosis

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This case report describes a rare complication of babesiosis: atraumatic splenic rupture. Babesiosis is a tickborne protozoal infection caused most commonly in the United States by <em>Babesia microti</em>, transmitted by the deer tick (*Ixodes scapularis*), and seen mainly in the Northeast and upper Midwest during the warmer months.

A 54-year-old previously healthy man presented with 5 days of fever, chills, fatigue, headache, and poor appetite. On admission, he was febrile and had anemia, thrombocytopenia, hyponatremia, elevated bilirubin, mild transaminitis, and lactic acidosis. A peripheral blood smear showed red blood cell inclusions consistent with babesiosis, with initial parasitemia of 5.2%. He was treated with atovaquone and azithromycin, plus doxycycline to cover possible Lyme disease.

During hospitalization, he developed syncope, worsening anemia requiring transfusion, and new abdominal pain and distension. CT imaging revealed an enlarged spleen with heterogeneous hypoenhancement and perisplenic fluid, consistent with splenic injury/hematoma. Because of concern for splenic rupture, he underwent celiac and splenic artery angiography with embolization of the proximal splenic artery. Persistent fevers later prompted exploratory laparotomy, which found an intraabdominal hematoma requiring washout and drain placement. He stabilized and was discharged on hospital day 11.

The report highlights that babesiosis can range from mild flu-like illness to severe disease with hemolytic anemia, ARDS, DIC, shock, and rare complications such as splenic infarction or rupture. Diagnosis is made by thin blood smear showing intraerythrocytic parasites, sometimes with the classic Maltese cross, and PCR can improve detection. Treatment in immunocompetent patients is typically atovaquone and azithromycin for 7–10 days. This case emphasizes the need to consider splenic rupture in babesiosis patients who develop abdominal pain or unexplained anemia.

Asset Subtitle

Adnan Alrashed

Meta Tag

Author List Adnan Alrashed, Jeffrey Mayne, Mark Carrasco

Category Clinical Vignettes

Concept Babesia microti

Concept Babesiosis

Concept Maltese cross tetrad

Concept Hemolytic Anemia

Concept Peripheral Blood Smear

Distinguished Non-Finalist

Presenter Organization Nuvance Health

Presenting Author Adnan Alrashed

Track Adult

Keywords

babesiosis

atraumatic splenic rupture

Babesia microti

tickborne infection

splenic hematoma

anemia

thrombocytopenia

peripheral blood smear

atovaquone and azithromycin

splenic artery embolization

Babesia microti

Babesiosis

Maltese cross tetrad

Hemolytic Anemia

Peripheral Blood Smear