Case Presentation: A 61-year-old male farmer presented to the emergency department with dyspnea and left upper quadrant abdominal pain of 3 days duration. He also noted fevers, chills, and night sweats. He recollected removing multiple ticks recently. He was febrile at 38.3ºC. Laboratory abnormalities included transaminitis and pancytopenia. Review of a peripheral blood smear revealed intraerythrocytic inclusions consistent with babesiosis. Computed tomography of the abdomen identified multiple small splenic infarcts, while imaging of the chest was unrevealing. Given the splenic involvement he was started on clindamycin and quinine for severe infection. Over the ensuing 72 hours the patient’s laboratory abnormalities stabilized, he defervesced, and his abdominal pain improved.
Discussion: Babesiosis has become an increasingly recognized tick-borne infection of the mid-Atlantic region over the past several years. Typical presenting symptoms are often non-specific and include fatigue, malaise, fevers, and chills. In rare instances acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and splenic infarction can occur. Splenic infarction, though an oft reported complication of malaria, has been reported infrequently in the literature in association with babesiosis. A physician must have an understanding of local epidemiologic patterns in relation to tick-borne illnesses to know when to consider them as diagnostic possibilities. Prompt recognition of babesiosis and its potential complications allows for initiation of therapy with decreased morbidity and mortality.
Conclusions: Once predominantly isolated to New England geography, babesiosis has become prominent in other areas of the eastern United States. This should prompt consideration in patients who present with non-specific summertime febrile illnesses and elevated transaminases, thrombocytopenia, leukopenia, and/or anemia. It is also important to recognize the rare, yet significant accompanying features such as splenic infarction, ARDS, and DIC as early initiation of treatment will significantly improve outcomes.
To cite this abstract:Rettew A, Shaikh B, Jehangir A, Bennett KM. Babesiosis and Splenic Infarction: A Rare Combination. Abstract published at Hospital Medicine 2016, March 6-9, San Diego, Calif. Abstract 762. Journal of Hospital Medicine. 2016; 11 (suppl 1). https://www.shmabstracts.com/abstract/babesiosis-and-splenic-infarction-a-rare-combination/. Accessed May 21, 2019.