Comment; We have been blessed with such good health in the developed world that we don’t often consider some of these more obscure yet potentially lethal illnesses. They can also have such varied and confusing presentations; difficult to recognize!
Daniel Chang, Md Hossain, Mohammed A. Hossain
Published: April 15, 2019 (see history)
DOI: 10.7759/cureus.4459
Cite this article as: Chang D, Hossain M, Hossain M A (April 15, 2019) Severe Babesiosis Masquerading as Thrombotic Thrombocytopenic Purpura: A Case Report. Cureus 11(4): e4459. doi:10.7759/cureus.4459
Abstract
Babesiosis is an infectious disease caused by protozoa of the genus Babesia. Its incidence has been increasing in the Northeast and upper Midwest regions of the United States in recent years. Symptoms of babesiosis can range from a mild flu-like illness to acute, severe, and fatal disease. Severe disease is common in older populations and immunocompromised patients. The laboratory abnormalities associated with babesiosis, such as low hematocrit, low hemoglobin, elevated lactate dehydrogenase, low haptoglobin, reticulocytosis, the presence of schistocytes on the peripheral blood smear and thrombocytopenia, can mimic other severe systemic disorders like thrombotic thrombocytopenic purpura (TTP). Hence, it is crucial to be aware of babesiosis, especially in highly endemic areas as it can masquerade as severe fatal systemic diseases like TTP.
Introduction
Microangiopathic hemolytic anemia (MAHA) is a non-immune intravascular hemolytic anemia characterized by the presence of schistocytes on peripheral blood smear [1]. Thrombotic thrombocytopenic purpura (TTP), a medical emergency and an almost uniformly fatal disease without appropriate treatment, can present with MAHA [2]. However, many different disorders, including systemic infections, malignancies, adverse drug reactions, severe hypertension, preeclampsia, systemic lupus erythematosus (SLE), allogeneic hematopoietic stem cell transplantation, and abnormalities of complement regulation also present with MAHA. Hence, it is essential to be aware of the etiologies of MAHA for appropriate and prompt treatment [3]. This article presents a case of human babesiosis presenting with MAHA and thrombocytopenia.
As the incidence of Babesia infection has been increasing across North America in recent years and as its clinical presentation of microangiopathic hemolytic anemia (MAHA) with thrombocytopenia is similar to other severe systemic disorders, it is crucial to be able to recognize all spectrums of babesiosis including the possibility of coinfection with other tick-borne diseases to prevent delays in diagnosis and treatment.
Conclusions
As the incidence of Babesia infection has been increasing across North America in recent years and as its clinical presentation of microangiopathic hemolytic anemia (MAHA) with thrombocytopenia is similar to other severe systemic disorders, it is crucial to be able to recognize all spectrums of babesiosis including the possibility of coinfection with other tick-borne diseases to prevent delays in diagnosis and treatment.
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