Symptomatic babesiosis in systemic lupus erythematosus: Report of a case and review of the literature

摘要

Symptomatic babesiosis is a complication of a disease transmitted to immunocompromised patients via tick-borne inoculation or through blood transfusion. We report a case of a 43-year-old African American woman with severe systemic lupus erythematosus that required renal transplantation and hemodialysis for renal failure and multiple transfusions for massive hemorrhaging from a colonic arteriovenous malformation. For treatment of persistent SLE activity, the patient was maintained on low-dose prednisone, hydroxychloroquine, and azathioprine. The patient developed high fevers and was found to have a hemolytic anemia with intraerythrocytic ring-shaped tro-phozoites characteristic of babesiosis. The patient was successfully treated without serious complications or relapse. Due to her history of multiple recent blood transfusions and lack of travel out of New York, it was believed that the disease was contracted from transfusions. Since babesiosis is a curable disease if recognized, and the fact that the blood supply is not screened for this parasite, the diagnosis should be entertained as another cause of opportunistic infection in systemic lupus erythematosus (SLE). A case is made for blood bank screening in endemic areas.