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

## TL;DR

A 74-year-old woman with severe babesiosis developed a rare heart condition called Takotsubo cardiomyopathy, highlighting the serious complications that can arise from tick-borne infections.

## Contribution

This case report presents a rare complication of babesiosis, linking it to stress-induced cardiomyopathy.

## Key findings

- Severe babesiosis can lead to Takotsubo cardiomyopathy, a form of stress-induced heart failure.
- The patient required intensive treatment, including exchange transfusion and mechanical ventilation, to manage complications.
- Early diagnosis and treatment are critical to prevent life-threatening outcomes in babesiosis.

## Abstract

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 Borrelia, Ehrlichia, Anaplasma, and Babesia, 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.