Davison Jenna, Kan Jonah, Gile Jennifer, Patgunarajah Ubenthira, Degenhardt Jeffry, Go Ronald, Abeykoon Jithma P
Department of Internal Medicine, Mayo Clinic, Rochester, USA.
Department of Hematology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
J Med Case Rep. 2025 Aug 11;19(1):400. doi: 10.1186/s13256-025-05466-x.
Warm autoimmune hemolytic anemia is characterized by destruction of red blood cells mediated by autoantibodies, which can be triggered by various underlying factors including tick-borne infections. Babesia spp. are protozoan parasites transmitted by tick bites that cause babesiosis and have been increasingly recognized as a potential precipitating factor for warm autoimmune hemolytic anemia.
This was a retrospective review of a single case where patient information was extracted from the electronic medical records after written informed consent was obtained. A literature review was also performed. We present a rare case of a 71-year-old White, non-Hispanic/Latino male patient with babesiosis and concurrent warm autoimmune hemolytic anemia. The patient initially presented with fever, chills, and anemia. A tick-borne illness panel was positive for Babesia microti. Despite therapy with doxycycline, azithromycin, and atovaquone, the hemoglobin continued to decline. This prompted investigation for autoimmune hemolytic anemia. A direct antiglobulin test revealed weak positivity for immunoglobulin G. After treatment with high-dose prednisone, the patient's hemoglobin gradually improved, and his liver enzymes normalized.
Given the increasing prevalence of tick-borne illnesses, physicians should have a high index of suspicion for concurrent warm autoimmune hemolytic anemia in patients with babesiosis and anemia not improving with typical therapies. In addition, the interplay between babesiosis and warm autoimmune hemolytic anemia underscores the need for clinicians to consider infectious etiologies in the workup of this disease.
温抗体型自身免疫性溶血性贫血的特征是由自身抗体介导的红细胞破坏，其可由包括蜱传播感染在内的各种潜在因素引发。巴贝斯虫属是通过蜱叮咬传播的原生动物寄生虫，可引起巴贝斯虫病，并且越来越被认为是温抗体型自身免疫性溶血性贫血的潜在诱发因素。
这是一项对单个病例的回顾性研究，在获得书面知情同意后从电子病历中提取患者信息。还进行了文献综述。我们报告一例罕见病例，一名71岁的非西班牙裔/拉丁裔白人男性患者患有巴贝斯虫病并并发温抗体型自身免疫性溶血性贫血。患者最初表现为发热、寒战和贫血。蜱传疾病检测显示微小巴贝斯虫呈阳性。尽管使用强力霉素、阿奇霉素和阿托伐醌进行治疗，但血红蛋白仍持续下降。这促使对自身免疫性溶血性贫血进行调查。直接抗球蛋白试验显示免疫球蛋白G弱阳性。在使用高剂量泼尼松治疗后，患者的血红蛋白逐渐改善，肝功能酶恢复正常。
鉴于蜱传疾病的患病率不断上升，医生对于患有巴贝斯虫病且贫血经典型治疗无改善的患者并发温抗体型自身免疫性溶血性贫血应保持高度怀疑。此外，巴贝斯虫病与温抗体型自身免疫性溶血性贫血之间的相互作用强调了临床医生在该疾病检查中考虑感染病因的必要性。
