Abstract: TH-PO086
An Unfortunate Outing
Session Information
- AKI: Clinical, Outcomes, and Trials - Epidemiology and Pathophysiology
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Farrell, Douglas R., Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Sedlacek, Martin, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Introduction
Tickborn illnesses are increasing in prevalence in part because of more ticks surviving milder winters. Here we present a case of AKI secondary to babesiosis induced hemolysis in a self described lifelong city dweller who spent all her life in Manhattan without travelling, except one excursion to the lower Hudson valley for a wedding where she noted an insect bite after a group hike.
Case Description
A 66 year old woman with a history of MGUS and breast cancer treated with lumpectomy, radiotherapy and on hormone therapy presented with fever, nightsweats, weight loss, dyspnea and weakness for three weeks. A month before falling ill she had noted an insect bite after a group hike on a wedding. She was cachectic on exam. The patient had pancytopenia WBC 2.8 Hb 6.5g/dl Plat 124, elevated LDH 1057U/L, acute kidney insufficiency with creatinine 1.44mg/dl and mildly elevated bilirubin 1.3g/dl, ALT 50U/L, AST 72U/L. Albumin was low 2.4g/dL, CK was normal, HIV was negative, a Coombs test was negative, her blood group was A positive, ADAMST13 activity was mildly decreased 63%, C3 low 64mg/dl and haptoglobin was undetectable. No schistocytes or inclusion bodies were seen on a blood smear. The urinalysis showed moderate blood with no RBC, typical for free heme as in hemolysis or rhabdomyolysis. The patient's AKI and mild hyponatemia resolved with IV saline. A diagnosis of babesiosis was made by PCR. There was no coinfection by oher tick borne pathogens. The patient was successfully treated with Atovaquone and azithromycin and all symptoms resolved. .
Discussion
The patient had pigment induced AKI from hemolytic anemia secondary to babesiosis. Babesia is a parasitie that utlizes RBC similar to malaria but without a liver phase, a smaller genome and not responding to artemisins. Babesiosis can cause severe illness in the elderly and the immunocompromised as this patient, who is a cancer survivor. As with malaria, certain blood groups reportedly have a protective effect but did not protect our patient (Non-B and Rhesus positive). A diagnosis of babesiosis is unexpected in a self described life long Manhattan resident who does not travel but went on a single outing to the countryside for a wedding. Babesiosis is an emerging global health problem and this patient illustrates how the numer of cases of babesiosis are likely to increase, even in unexpected places.