Acute Respiratory Distress Syndrome From Transfusion Transmitted Babesiosis in a Trauma Patient With Systemic Lupus Erythematosus

Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

ntroduction Babesia microti is a microcytic intracellular parasite that infects red blood cells in humans and is the main form of babesiosis in the US. It is transmitted by Ixodes scapularis tick and is commonly found in the Northeast and upper Midwest states. In May 2019 FDA recognized Babesiosis as a Transfusion Transmitted Infection (TTI) and necessitated year-round testing using nucleic acid tests in these endemic states of which Indiana is not included. Severe parasitemia (>4%) is complicated by Acute Respiratory Distress Syndrome (ARDS), anemia, heart failure, renal failure, disseminated intravascular coagulation, shock, and coma. We present the case of a trauma patient with Systemic Lupus Erythematosus (SLE) on immune suppression who developed ARDS during her hospital stay due to Babesia microti. Description 25-year-old woman with history of SLE/Mixed Connective Tissue Disease, lupus nephritis, and ongoing immunosuppressive therapy with azathioprine, hydroxychloroquine, and prednisone bursts was admitted for a motor vehicle accident in Indiana resulting in subdural hematoma. She underwent craniectomy and treatment for her injuries before being transferred to the floor. One week after admission she received red blood cell transfusion for Hgb < 7 g/dl which was followed by fever, chills, and hypoxemia. She was readmitted to the ICU for a transfusion reaction. Three days later she developed extensive bilateral pulmonary infiltrates, severe hypoxemia and altered mentation requiring urgent intubation. She was empirically treated for hospital acquired pneumonia and opportunistic organisms due to her immunocompromised state. After a comprehensive workup for sepsis, her blood smear was positive with intraerythrocytic inclusions, and serology was sent for Babesia, Malaria, Lyme, and other tick-borne illnesses. Diagnosis of Babesiosis was made based on positive serology, polymerase chain reaction, and repeat smears. Azathioprine was stopped and she was started on atovaquone and azithromycin. In view of multiorgan involvement with 5% parasitemia, exchange blood transfusion was initiated. ARDS improved but subsequent hospital stay is complicated by subdural empyema, herpes simplex pneumonia and prolonged tracheostomy dependent respiratory failure. Discussion We believe that this is the first report of transfusion-transmitted babesiosis in a patient with Lupus. Most cases of Babesia in immunocompromised have been in relation to asplenia, cancer, HIV, or old age. Our report underscores the significance of Babesia screening, extending beyond a typical infectious workup in the severely immunocompromised. Physicians should maintain a high index of suspicion for babesiosis in post-transfusion multiorgan failure, advocating for expanded blood product screening even in non-endemic areas.

Volume

209

Issue

Suppl

First Page

A1144

Comments

International Conference of the American Thoracic Society, May 17-22, 2024, San Diego, CA

DOI

10.1164/ajrccm-conference.2024.209.1_MeetingAbstracts.A1144

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