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Babesiosis. Diagnostic pitfalls
1Department of Pathology, Beth Israel Hospital, Boston, Massachusetts 02215.
American Journal of Clinical Pathology
|June 1, 1991
Summary
This case study highlights a rare complication of babesiosis in a splenectomized patient, where quinine therapy unexpectedly caused severe hemolysis and Pappenheimer bodies, mimicking parasitic infection.
Area of Science:
- Medical Case Reports
- Parasitology
- Hematology
Background:
- Babesiosis is a tick-borne parasitic disease.
- Splenectomized individuals are at higher risk for severe babesiosis.
- Quinine is an antimalarial drug with known hemolytic side effects.
Observation:
- A splenectomized woman developed babesiosis after travel to an endemic region.
- Initial presentation included fever and mild hemolysis, which worsened during treatment.
- Increased red blood cell inclusions were observed, initially mistaken for Babesia.
Findings:
- Quinine therapy, not babesiosis alone, was identified as the cause of increased hemolysis.
- Iron staining revealed hemolysis-induced Pappenheimer bodies, distinct from Babesia parasites.
- The clinical laboratory played a crucial role in differentiating these conditions.
Implications:
- This case underscores the importance of considering drug-induced hemolysis in complex parasitic infections.
- Accurate laboratory diagnostics are vital for distinguishing parasitic forms from artifactual inclusions.
- Clinicians should be aware of potential quinine toxicity, especially in vulnerable patient populations.