DOI: 10.3138/guthrie-2026-0010 ISSN: 2819-1684

Fatal Babesiosis with Multiorgan Failure in an Older Adult with Multiple Comorbidities

Shubhendu Bajpai, Abdullah Sultany, Asmita Paudel, Andrew Vela, Kevin Carroll, Eric Macapinilac, Faraz Siddiqui
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Abstract

Background:

Babesiosis is an emerging tick-borne disease caused by intraerythrocytic protozoa of the genus Babesia . Severe manifestations disproportionately affect older adults and individuals with compromised immune function. The present report details a fatal case of severe babesiosis with rapid progression to multiorgan failure despite prompt initiation of appropriate antimicrobial therapy.

Case Presentation:

An older adult male with a history of monoclonal gammopathy of undetermined significance, chronic obstructive pulmonary disease, essential hypertension, and prior Lyme disease presented with jaundice, fatigue, and shortness of breath following recent tick exposure. Peripheral blood smear demonstrated intraerythrocytic inclusions consistent with Babesia species, and parasitemia exceeded 10%. Despite initiation of atovaquone, azithromycin, and doxycycline, the patient developed progressive hemolytic anemia, acute kidney injury, severe lactic acidosis, respiratory failure, and distributive shock. Mechanical ventilation, vasopressors, and continuous renal replacement therapy were required. A transfer for exchange transfusion was attempted but could not be completed before clinical deterioration. The patient died on hospital day 5 after transition to comfort-focused care.

Conclusion:

This case highlights the fulminant trajectory of severe babesiosis in older adults with multiple comorbidities. Early recognition of high-risk features and timely access to exchange transfusion remain critical in the management of severe disease.

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