A52-02 Babesia Induced Acute Respiratory Distress Syndrome in a Patient With Systemic Lupus Erythematosus

Introduction Acute respiratory distress syndrome (ARDS) has previously been described as a rare complication of babesia infection1. Age, immunocompromised state, autoimmunity, and blood disorders are significant risk factors that have been identified in prior cases of severe babesia complications1. Further research on specific risk factors for development of severe complications is needed1. Here we describe an unusual case of babesia induced ARDS in a patient with known, stable systemic lupus erythematosus (SLE). Case This is a 78-year-old female with a past medical history of SLE (on maintenance hydroxychloroquine and 5 mg prednisone daily), stage IV chronic kidney disease, hypothyroidism, chronic anemia, type 2 diabetes, bilateral carotid artery stenosis status post left carotid artery stent, peripheral arterial disease, hyperlipidemia, and hypertension who presented with generalized weakness, fatigue, and fevers. She reported multiple tick bites approximately one month prior to presentation. Shortly after admission, blood smear revealed 0.5% parasitemia with intraerythrocytic trophozoites and babesia polymerase chain reaction was positive, consistent with a diagnosis of babesiosis. She was started on atovaquone and azithromycin. Following initiation of treatment, she became progressively dyspneic and developed hypoxia, to a peak oxygen requirement of 50 L/min 90% FiO2 high flow nasal cannula (PaO2/FiO2 123). Chest x-ray and CT chest imaging revealed bilateral consolidations consistent with a diagnosis of ARDS. Small bilateral effusions were present; however, transthoracic echocardiogram demonstrated normal left ventricular function without evidence of elevated filling pressures, making cardiogenic pulmonary edema unlikely. She was transferred to the intensive care unit (ICU) over this course for close respiratory monitoring and consideration of exchange transfusion. She responded well to conservative treatment with significant improvement in respiratory status while in the ICU, avoiding the need for intubation and exchange transfusion. She was discharged off oxygen to a rehab facility after a twelve day hospital course, to complete fourteen total days of treatment. Discussion This case demonstrates a severe complication of babesiosis in a patient with very low parasitemia (peak parasitemia level of 0.5%) but with significant underlying risk factors. Patients with SLE may be at elevated risk for significant babesia related complications due to their immunocompromised state and presence of a dysregulated immune system. References (1) Yune PS, Islam I, Dicpinigaitis PV, Daily JP, Weiss LM, Park SO. A Case Report and Literature Review of Babesiosis-Induced Acute Respiratory Distress Syndrome. Case Rep Infect Dis. 2022 Nov 12;2022:4318731. This abstract is funded by: None