SHM Converge Scientific Abstract ePoster Gallery-Unwelcome Visitor: Fulminant Babesiosis After a Trip to the Countryside

Pdf Summary

A woman presented with severe hemolytic anemia, thrombocytopenia, acute kidney injury, hyperbilirubinemia, and marked LDH elevation after a recent trip to the Hamptons. Initial labs showed WBC 5.2/µl, hemoglobin 9 g/dl, platelets 46,000/mm3, creatinine 4.36, total bilirubin 4.6 mg/dl, LDH 16,570 U/L, haptoglobin 20 mg/dl, reticulocytes 20%, and a negative direct Coombs test. She was initially treated with fluids and broad-spectrum antibiotics, but remained hypotensive and developed worsening renal failure requiring vasopressors and hemodialysis.<br /><br />Because thrombotic microangiopathy was suspected, a peripheral blood smear was reviewed. Instead of schistocytes, it showed numerous intraerythrocytic ring-forming parasites, with a parasite burden of 22%. Given her travel history to an endemic area, babesiosis was suspected and treatment with azithromycin and atovaquone was started. Polymerase chain reaction later confirmed Babesia microti infection.<br /><br />This case highlights fulminant babesiosis as an important cause of severe hemolysis, multiorgan dysfunction, and shock, especially after exposure in tick-endemic regions. Early review of the blood smear was key to diagnosis and timely therapy.

Asset Subtitle

Maryam Hajiabbasi

Meta Tag

Author List Joonkyung Lee, Maryam Hajiabbasi, Nagma Shah, Navin Bhatt, Robert Thompson, Shristi Nepal

Category Clinical Vignettes

Concept Babesiosis

Concept Fulminant babesiosis

Concept Hemolytic Anemia

Concept Peripheral Blood Smear

Concept Intraerythrocytic parasites

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Maryam Hajiabbasi

Track Adult

Keywords

babesiosis

Babesia microti

hemolytic anemia

thrombocytopenia

acute kidney injury

hyperbilirubinemia

elevated LDH

blood smear

tick-endemic region

multiorgan dysfunction

Babesiosis

Fulminant babesiosis

Hemolytic Anemia

Peripheral Blood Smear

Intraerythrocytic parasites