Dr. Derek Monette: Today's case is that of a 46-year-old male with recent diagnoses of Lyme disease
and babesiosis who presented to our emergency department (ED) with abdominal pain,
nausea, and diarrhea. The patient was previously healthy and had been well until approximately
2 weeks before the day of ED presentation, when he developed headache, fatigue, and
myalgias. He also noticed that his right calf “looks sunburned,” and was warm to the
touch. He was evaluated by his primary care physician (PCP) after 1 week of symptoms.
A screening enzyme-linked immunosorbent assay for Lyme, ordered by his PCP, was positive,
and he was subsequently started on doxycycline. His follow-up Lyme IgM Western blot
was positive, and an IgG Western blot was equivocal. Three days later, he developed
fever to 101°F, a dry cough, and worsening myalgias. His PCP obtained a chest x-ray
study, which did not show any pathology. Laboratory studies from the second PCP visit
revealed hemoglobin and hematocrit of 13.5 g/dL and 39.7%, respectively, in addition
to a platelet count of 62,000/μL, alanine aminotransferase (ALT) of 93 U/L, and aspartate
aminotransferase (AST) of 75 U/L. A blood smear for babesia was performed and returned
with a positive result, at 0.3% parasitemia. The patient was referred to an infectious
disease (ID) specialist and was started on atovaquone and azithromycin. He started
these medications the night before presenting to the ED for evaluation of his new
abdominal pain, nausea, and diarrhea.
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References
- Acute mesenteric ischemia.Surg Clin North Am. 1997; 77: 307-318
- Does doxycycline protect against development of Clostridium difficile infection?.Clin Infect Dis. 2012; 55: 615-620
- Babesiosis.Infect Dis Clin North Am. 2015; 29: 357-370
- Human babesiosis.N Engl J Med. 2012; 366: 2397-2407
- Severe babesiosis in Long Island: review of 34 cases and their complications.Clin Infect Dis. 2001; 32: 1117-1125
- Diagnosis, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: a review.JAMA. 2016; 315: 1767-1777
- Splenic infarction in human babesiosis: two cases and discussion.Clin Infect Dis. 2008; 46: e8-e11
- Case report: spontaneous splenic rupture during acute parasitemia of Babesia microti.Ann Clin Lab Sci. 2008; 38: 390-392
- Spontaneous splenic rupture caused by Babesia microti infection.Clin Infect Dis. 2008; 46: e92-e95
- Risk factors for severe infection, hospitalization, and prolonged antimicrobial therapy in patients with babesiosis.Am J Trop Med Hyg. 2017; 97: 1218
- Systematic review of atraumatic splenic rupture.Br J Surg. 2009; 96: 1114-1121
- Human babesiosis in New York State: review of 139 hospitalized cases and analysis of prognostic factors.Arch Intern Med. 1998; 158: 2149-2154
- Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness.JAMA. 1996; 275: 1657-1660
- On the clinical detection of enlargement of the spleen.Australas Ann Med. 1953; 2: 78-80
- Non-operative management and immune function after splenic injury.Br J Surg. 2012; 99: 59-65
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Published online: August 31, 2019
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