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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Published online: August 31, 2019
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