From Tick Bite to Broken Heart: A Case of Stress Cardiomyopathy Induced by Severe Babesiosis

Babesiosis can present with a wide range of clinical manifestations, from asymptomatic infection to severe, life-threatening illness. We report the case of a 74-year-old woman with severe babesiosis complicated by Takotsubo cardiomyopathy. She presented with fever, chills, fatigue, and shortness of breath two weeks after a tick bite of unknown attachment duration. Initial testing for tick-borne illnesses, including <i>Borrelia</i>, <i>Ehrlichia</i>, <i>Anaplasma</i>, and <i>Babesia</i>, was negative. As her condition progressed, she developed hemolytic anemia, and a repeat peripheral blood smear revealed 4.5% parasitemia, confirming severe babesiosis. Despite treatment with atovaquone and azithromycin, her clinical status deteriorated, necessitating exchange transfusion, mechanical ventilation for respiratory failure, and hemodynamic support with inotropes and vasopressors for refractory cardiogenic shock. Echocardiography confirmed Takotsubo cardiomyopathy, which resolved with appropriate treatment. This case underscores the diagnostic complexity and potential severity of babesiosis, highlighting the importance of maintaining a high index of suspicion and initiating prompt therapy to prevent serious complications.