Babesiosis Masquerading as Evans Syndrome

A 65-year-old woman presented with fatigue and fever for 4 days. She was taking prednisone for systemic lupus erythematosus and autoimmune hepatitis, and had undergone splenectomy for immune thrombocytopenia at the age of 20 years. On presentation, she looked ill and was febrile and hypotensive. Hemoglobin was 10.9 g/dL, white blood cell count 11 × 10⁹/L, platelet count 109 × 10⁹/L, reticulocyte count 0.25 M/μL, lactate dehydrogenase 3451 U/L, indirect bilirubin 1.9 mg/dL, and haptoglobin <20 mg/dL.

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-Simran A. Elder, MD^a,b, Jennifer J. O’Brien, MD^c,d, Zeba N. Singh, MD^c, Emily Wilding, MD^c, Ann B. Zimrin, MD^a,b, Jennie Y. Law, MD^a,b, Maria R. Baer, MD^a,b

This article originally appeared in the July 2019 issue of The American Journal of Medicine.