Cirra Vidyasagar R, Kommu Sharath, Husak Michael, Osterbauer Christopher
Department of Hospital Medicine, Marshfield Clinic, Rice Lake, Wisconsin, USA.
Department of Hematology and Oncology, Marshfield Clinic, Rice Lake, Wisconsin, USA.
Case Rep Hematol. 2025 Jul 1;2025:9918329. doi: 10.1155/crh/9918329. eCollection 2025.
A 76-year-old man with a history of atrial fibrillation treated with warfarin, renal calculi with a history of lithotripsy, hypertension, anxiety, and diabetes mellitus with recent tick exposure presented with abdominal pain, fatigue, nausea, and fever with chills. Workup revealed thrombocytopenia and hemolysis. Due to the likelihood of immune thrombocytopenia (ITP) secondary to a viral etiology, the patient was initially started on steroids. The patient subsequently tested positive for babesiosis on peripheral smear and polymerase chain reaction. A peripheral smear showed giant platelets and was positive for immunoglobulin M platelet antibodies. Other etiologies of thrombocytopenia were excluded. The patient was diagnosed with ITP secondary to babesiosis. Antibiotics were initiated to treat babesiosis. The platelet count was nonresponsive to steroids and gradually improved following intravenous immunoglobulin administration and continued antibiotic treatment. This rare case highlights the importance of considering ITP secondary to babesiosis as the etiology of severe thrombocytopenia in babesiosis, as appropriate recognition and early treatment of babesiosis and ITP can prevent serious complications.
一名76岁男性，有房颤病史，接受华法林治疗，有肾结石并曾接受碎石术，患有高血压、焦虑症和糖尿病，近期有蜱虫接触史，出现腹痛、乏力、恶心、发热伴寒战。检查发现血小板减少和溶血。由于可能是病毒病因继发的免疫性血小板减少症（ITP），患者最初开始使用类固醇治疗。随后患者外周血涂片和聚合酶链反应检测巴贝斯虫病呈阳性。外周血涂片显示巨大血小板，免疫球蛋白M血小板抗体呈阳性。排除了血小板减少的其他病因。患者被诊断为巴贝斯虫病继发ITP。开始使用抗生素治疗巴贝斯虫病。血小板计数对类固醇无反应，静脉注射免疫球蛋白并持续抗生素治疗后逐渐改善。这个罕见病例凸显了将巴贝斯虫病继发ITP视为巴贝斯虫病中严重血小板减少病因的重要性，因为对巴贝斯虫病和ITP的适当识别和早期治疗可预防严重并发症。
