A Rare Case of Shock in a Patient with Non-Severe Range Babesiosis

Babesiosis is a tickborne illness caused by microscopic parasites that infect red blood cells. Infections present on a spectrum from asymptomatic to severe, life-threatening presentations. However, life-threatening disease is more typically seen in patients who are asplenic, immunocompromised, or with hepatic/renal disease. We present an unusual case of babesiosis where an immunocompetent patient with age as the only risk factor, became extremely ill with relatively low parasite burden and no co-infection with other tickborne illnesses. A 73-year-old man with essential hypertension and remote prior Lyme disease infection presented to the hospital in late Spring due to acute mental status change after being found acting erratically by police. Upon presentation, he was hypotensive to 70/40 mmHg, tachycardic, and unable to follow commands. Blood parasite smear was positive for Babesia species with 2.2% parasitemia. Ehrlichia, Anaplasma and Lyme IgM species testing was negative. The patient required treatment of septic shock with norepinephrine. Along with azithromycin and atovaquone, he ultimately underwent three exchange transfusions due to significant hemolytic anemia. This led to dramatic improvement in his mental status and he was discharged with 10 additional days of antibiotics. Babesia infections present heterogeneously ranging from asymptomatic to life-threatening presentations with hypotension, hemolysis, thrombocytopenia, DIC, organ failure, and even death, especially in patients with risk factors. Our patient had a critical presentation without an immunocompromised state, no prior splenectomy, lack of liver/renal abnormalities, and relatively low parasitemia. Additionally, exchange transfusion can be considered with hemolysis despite non-severe range parasitemia

A case of atypical scleroderma renal crisis

We present the case of a 63-year-old female diagnosed with atypical SSc in the setting of acute SRC. She was undergoing work-up for progressive dyspnoea in the outpatient setting when she was found to have newly diagnosed restrictive lung pathology and worsening renal function, thus prompting acute hospital admission. Given multisystem involvement of the pulmonary and renal systems, the differential diagnosis included autoimmune and connective tissue disorders. Although serologies were non-specific, renal biopsy confirmed scleroderma renal disease, and she was started on treatment with captopril. This case highlights the importance of clinical judgment and timely diagnosis, even when laboratory data might indicate otherwise

A Case of Atypical Scleroderma Renal Crisis.

We present the case of a 63-year-old female diagnosed with atypical SSc in the setting of acute SRC. She was undergoing work-up for progressive dyspnoea in the outpatient setting when she was found to have newly diagnosed restrictive lung pathology and worsening renal function, thus prompting acute hospital admission. Given multisystem involvement of the pulmonary and renal systems, the differential diagnosis included autoimmune and connective tissue disorders. Although serologies were non-specific, renal biopsy confirmed scleroderma renal disease, and she was started on treatment with captopril. This case highlights the importance of clinical judgment and timely diagnosis, even when laboratory data might indicate otherwise. LEARNING POINTS: Scleroderma renal crisis (SRC) remains an important cause of morbidity and mortality in systemic sclerosis (SSc), and clinicians should have a high index of suspicion to diagnose it.The absence of specific serologic markers makes SSc diagnosis challenging and necessitates reliance on clinical findings and additional diagnostic tools such as imaging studies and tissue sampling