Splenic Infarction in Babesiosis: A Case Series

Babesiosis is an intraerythrocytic tick-borne illness with a rising incidence in the northeastern United States that can be complicated by splenic infarction and atraumatic rupture. We report three cases of splenic infarcts and pose the question: Should certain patients with Babesia species-induced splenic infarcts receive therapeutic anticoagulation? Splenic infarct, with or without rupture, is a rare yet increasingly reported complication of babesiosis. This complication does not appear to be correlated with the degree of parasitemia. There are no guidelines for the management of Babesia species-induced splenic infarcts. While therapeutic anticoagulation may be indicated for splenic infarcts due to other etiologies, the decision to anticoagulate patients with babesiosis remains on a case-by-case basis, as the mechanism of infarct-thrombus formation, coagulation system activation, or red blood cell sequestration-remains unknown. Future studies may be warranted to elucidate the mechanism of splenic infarction secondary to babesiosis, as well as to assess the safety and efficacy of anticoagulation use. Clinicians must be aware of the risk of splenic infarction in Babesia species infections. We report three cases of infection complicated by splenic infarct and discuss the role of anticoagulation. The decision to anticoagulate is individualized and determined by clinical features such as the presence of infarct-related symptoms and overall bleeding risk.