Splenic infarct, atypical presentation of babesiosis: A case report

Abstract

Babesiosis is a tick-borne protozoan infection marked by invasion of red blood cells and causing hemolytic anemia. When symptomatic, patients present with symptoms and signs secondary to hemolysis. We report a case of Babesiosis presenting with a rare manifestation of a splenic infarct, emphasizing the importance of early recognition and prompt treatment. A 41-year-old man with no significant past medical history presented to the hospital with fever, chills and sweats for 2 days. He also had left lower quadrant abdominal pain which started 10 days prior to the admission. Initial laboratory results showed mild anemia and thrombocytopenia with a platelet count of 79 K/uL (normal range 150-350), normal creatinine and transaminases. Computerized tomography (CT) of the abdomen showed moderate splenomegaly and 1.2 cm hyperdense focus reflecting an infarct. Peripheral blood smear demonstrated intracellular red cell inclusions suggestive of Babesia spp. Human Babesiosis is an emerging zoonosis with various clinical presentations varying from being asymptomatic to life-threatening conditions. Patients with immunocompromised status, splenectomy, or significant underlying health conditions are particularly susceptible to severe manifestations. Splenic infarcts are reported as a rare complication, found in younger and immunocompetent hosts, and they do not correlate with the level of parasitemia. Our patient was also a young immunocompetent host with a low level of parasitemia presented with abdominal pain; a high level of suspicion is needed to make an early diagnosis. This case is an important reminder of this atypical presentation of Babesia microti infection in an immunocompetent host.