Case Presentation: A 39-year-old construction worker with no past medical history presented to the hospital with a 2-week-history of fatigue and left upper quadrant abdominal pain associated with intermittent high fevers and chills. Patient reports his 9-year-old daughter was sick with fevers and an upper respiratory tract infection a month ago right after a camping trip to Pennsylvania they all went on. On initial presentation, patient met SIRS criteria with fever of 39.1 °C, tachycardia and hypotension. Patient appeared uncomfortable with significant left upper quadrant tenderness and found to have splenomegaly on physical exam. Laboratory results were significant for hemolytic anemia, thrombocytopenia and mild transaminitis. HIV antibody, urinalysis blood cultures and chest radiograph were all negative. CT scan of the abdomen showed splenomegaly with multiple splenic infarcts. A malaria screen was negative for Epstein-Barr virus serology, Ehrlichia antibodies and Lyme serology but positive for Babesia with a parasite count of 1.2%. Patient was subsequently started on Atovaquone and Azithromycin. By discharge, the patient’s parasite count gradually improved and thrombocytopenia had resolved. Outpatient abdominal ultrasound performed 6 weeks after discharge revealed resolution of the patients’ splenomegaly.
Discussion: Babesiosis, a malaria-like parasitic disease, is usually transmitted by the Ixodes scapularis tick having an incubation period of one to four weeks. Patients usually presents with nonspecific flu-like symptoms such as fever, fatigue, chills, sweats in addition to laboratory findings of hemolytic anemia, thrombocytopenia and transaminitis. An unusual symptom that rarely is seen is left upper quadrant abdominal pain caused by splenomegaly with findings consistent of splenic infarctions as seen in our patient. Usually an asymptomatic infection in healthy individuals, Babesiosis can cause severe complications depending upon the host’s immune status with significant morbidity and mortality if not identified in time. This rare complication of Babesiosis has been reported in only a very few cases, only mostly in immunocompromised patients greater than 50 years old and rarely in young previously healthy individuals like our patient.
Conclusions: Endemic to the Northeast region of the United States particularly in New England, Babesiosis has never been reported in Pennsylvania based on the CDC’s data as of 2017. Fever, fatigue and left upper quadrant pain with splenomegaly in a young immunocompetent patient is usually seen in patients infected with the Epstein-Barr virus prompting supportive care compared to the antibiotics needed to treat Babesiosis. Typically seen in older immunocompromised patients, severe symptomatic Babesiosis can also be seen in younger healthy individuals. This case also highlights the importance of keeping up with the current trends of the increasing prevalence of tick-borne diseases that are emerging in addition to their spread as the climate changes.