Babesiosis unmasked in chronic lymphocytic leukemia: A case report

Chronic lymphocytic leukemia (CLL)-related autoimmune cytopenias are common. Herein, we present the case of a patient with bicytopenia (anemia and thrombocytopenia), weakly positive direct Coombs test, and increased hemolytic markers. Cytopenias were initially presumed to be autoimmune and related to CLL. He was started on prednisone but to no effect. This prompted re-evaluation of peripheral blood smear which showed intra-erythrocytic inclusions. Considering the patient’s recent extensive hiking in tick-endemic areas and current residence in New York State, polymerase chain reaction for Babesia was performed, yielding a positive result. Treatment with atovaquone and azithromycin for 6 weeks resulted in a significant improvement in both cytopenias and hemolytic markers.