Severe babesiosis andBorrelia burgdorferico-infection

Abstract

A 73-year-old man from upstate New York visited his primary care physician with a bull’s eye rash in his right arm and fatigue. He traveled to the state of Massachusetts in the week before the lesion’s appearance, where he spent most of his time outdoors and had a tick bite in that same arm. He was initially diagnosed with Lyme disease and was given a prescription for amoxicillin. The fatigue persisted, and 3 weeks later, he presented to our hospital with intermittent fever (38.8°C), chills and night sweats. His medical history was remarkable for coronary heart disease and coronary artery bypass graft surgery. On physical examination, the patient was febrile and tachycardic with a normal respiratory rate. The rest of the examination was otherwise unremarkable. No distinctive rashes, jaundice, lymphadenopathy, swollen joints or hepatosplenomegaly were appreciated. Initial laboratory studies revealed thrombocytopenia (60 × 109/l) with normal white and red blood cell counts; they also showed undetectably low levels of haptoglobin, unconjugated hyperbilirubinemia, increased fraction of reticulocytes (6.1%) and elevated lactate dehydrogenase levels (726 U/l), all consistent with early hemolysis. A radiography of the chest yielded normal findings. Lyme disease was confirmed by elevated indirect immunofluorescent antibodies, immunoglobulin (Ig)M and IgG fractions, against Borrelia burgdorferi . A peripheral blood smear was examined under light …