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Transfusion-Associated Babesiosis with an Atypical Time Course after Nonmyeloablative Transplantation for Sickle Cell Disease
- Christopher M. Cirino, DO;
- Susan F. Leitman, MD;
- Esther Williams;
- Daniel Fedorko, PhD;
- Tara N. Palmore, MD;
- Amy Klion, MD;
- Christian Ockenhouse, MD, PhD;
- Courtney Fitzhugh, MD;
- John F. Tisdale, MD; and
- Matthew M. Hsieh, MD
- From St. Vincent Health Center, Erie, PA 16544; National Institute of Diabetes and Digestive and Kidney Diseases, Warren Grant Magnuson Clinical Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892; and Walter Reed Army Institute of Research, Silver Spring, MD 20910.
Background: Babesiosis is a tick-borne zoonosis that is increasingly recognized as a transfusion-associated infection (1).
Objective: To describe a case of transfusion-associated babesiosis presenting with an atypical time course after nonmyeloablative, peripheral blood stem-cell transplantation.
Case Report: A 21-year-old Puerto Rican woman underwent nonmyeloablative peripheral blood stem-cell transplantation at the National Institutes of Health in October 2005 for hydroxyurea-refractory, severe sickle cell disease. Her peritransplant course was unremarkable, hemoglobin level normalized, and hemoglobin electrophoresis revealed donor type (hemoglobin AS). Her last blood product transfusion was in October 2005. She received long-term Pneumocystis prophylaxis with trimethoprim–sulfamethoxazole and underwent periodic therapeutic phlebotomy for iron overload.
In April 2006, she returned for evaluation of daily fever to 39 °C for 1 month. She defervesced during a 2-week course of levofloxacin therapy for presumed sinusitis, yet fever returned after completion of treatment and was accompanied by neck pain, arthralgias, lightheadedness, palpitations, and severe fatigue. On examination, she had marked pallor, nuchal rigidity, and a systolic flow murmur. Her hemoglobin level was 6.2 g/dL with an absolute reticulocyte …
