Babesiosis as a Cause of Atraumatic Splenic Injury: Two Case Reports and a Review of Literature

• Published in: Journal of general internal medicine : JGIM Vol. 36; no. 12; pp. 3869 - 3874
• Main Authors: Sung, Lily H., Sundaram, Ayesha H., Glick, Andrew L., Chen, Daniel F., Shipton, Linda
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-12-2021; Springer Nature B.V
• Subjects: Abdomen; Anemia; Arachnids; Atovaquone; Azithromycin; Babesia; Babesia microti; Babesiosis; Babesiosis - complications; Babesiosis - diagnosis; Babesiosis - drug therapy; Blood; Case reports; Clinical Vignette; Complications; Coronaviruses; COVID-19; Diagnosis; Disease transmission; Drug use; Gastrointestinal surgery; Hemoglobin; Hemolytic anemia; Hemorrhage; Hospitals; Humans; Infarction; Infections; Injuries; Internal Medicine; Literature reviews; Lyme disease; Malaria; Medical imaging; Medicine; Medicine & Public Health; Pain; Parasitemia; Parasites; Pathogens; Patients; Spleen; Thrombocytopenia; Trauma; Ultrasonic imaging; Vital signs
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-021-07117-5

We present two cases of
Babesia
-induced splenic injury at a single institution. In the late summer, two patients presented with left-sided abdominal pain radiating to the shoulder. They were both found to have hemolytic anemia, thrombocytopenia, and acute splenic infarction on imaging. Blood smears showed intracellular ring forms consistent with
Babesia
spp. and low parasitemia (<1%). Diagnosis was confirmed by PCR for
Babesia microti
. Both patients improved with azithromycin and atovaquone, without blood products or surgical intervention. Several weeks following treatment, repeat blood smears revealed no parasites. Splenic infarct and hemorrhage have been previously reported as rare complications of babesiosis. However, given the steady rise in
Babesia microti
cases in the USA, even these rare complications will become more prevalent. We review both the diagnosis and management of
Babesia
-induced splenic complications, which can be challenging in patients with low-level parasitemia. Clinicians should consider babesiosis as a cause of atraumatic splenic injury.