(652) Surviving the Perfect Storm: A Rare Case of Severe Babesiosis Complicated by Multiorgan Failure

Introduction: Babesiosis is a tick-borne parasitic infection caused by intraerythrocytic protozoa of the genus Babesia. This vector-borne illness is endemic to the Northeast and Midwest United States and manifests as a coinfection with other tick-borne illnesses. While it often remains asymptomatic or manifests mildly in immunocompetent hosts, it can precipitate severe and life-threatening complications. Herein, we present a case of severe babesiosis in a previously healthy septuagenarian initially diagnosed with a viral illness and subsequently rapidly progressed to multiorgan failure.

Description: A 73-year-old, healthy male from the Northeast United States presented with fever, nausea, and generalized body aches. Initially, he had non-specific complaints that resembled a viral illness. However, his condition quickly worsened, leading to severe acidosis, renal failure, and multi-organ failure with shock. High-grade parasitemia consistent with babesiosis was identified. He developed acute respiratory distress syndrome necessitating intubation and experienced spontaneous splenic rupture requiring emergent splenic artery embolization. Due to the parasitemia burden, he underwent apheresis treatment. His clinical course was further complicated by spontaneous subdural hematoma, secondary to severe thrombocytopenia and disseminated intravascular coagulation. Throughout the hospital course, continuous renal replacement therapy was necessitated by anuria. Ultimately, he received high dose atovaquone and azithromycin, which proved successful, in conjunction with doxycycline administrated to treat a confirmed coinfection with Lyme disease.

Discussion: This case report is a stark reminder of the potential severity of babesiosis and underscores the crucial importance of timely diagnosis and treatment. Well documented diagnostic challenges posed by non-specific initial symptoms further complicates the clinical picture. In this instance, the patient's presentation mimicked a viral illness, resulting in a delayed diagnosis until the condition progressed to multi-organ failure attributed to babesiosis. This emphasizes the necessity for healthcare providers to maintain a high index of suspicion for tick-borne illnesses in patients presenting with compatible symptoms and relevant exposure history.