AN UNCOMMON CONCURRENCE OF BABESIOSIS AND ACETAMINOPHEN OVERDOSE: CASE REPORT

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Babesiosis is a tick-borne illness caused by B. microti and other species transmitted the Ixodes tick. Acute respiratory distress syndrome (ARDS) can be manifestation babesiosis. CASE PRESENTATION: A 69 year old female with past medical history HTN, HLD hypothyroidism who presented to hospital for 1 week intermittent fever generalized body aches. Patient denied any tick bites. She started have around 40°C, nonproductive cough aches, associated night sweats, nausea, diarrhea. took 1000mg Tylenol every 4 hours aches without improvement.Upon admission laboratory values were significant hemolytic anemia (Hgb 9.4 g/dL, reticulocyte count 1.2%, LDH 4896 U/L, haptoglobin < 8mg/dL, total bilirubin 2.3 mg/dL), thrombocytopenia (platelet 38× 103/mm3) leukopenia (WBC 2.7× 103/mm3), significantly elevated acetaminophen level (22.6), transaminitis (ALT 365 IU/L, AST 579 IU/L) INR (1.4). Blood parasite smear was positive blood parasites (Malaria/Babesia: 9.6% RBC infected). Babesia Microti DNA RT-PCR positive, Ab (IgM) ≥ 1:320, (IgG) 1:512, E. Chaffeensis Ig G <1:64, M <1:20, Lyme Scr-Q <0.90. HIV culture negative. SARS-CoV-2 RNA negative.Patient admitted received Acetylcysteine toxicity, atovaquone, azithromycin, doxycycline borreliosis coverage. On day 2 admission, decreased less than 10, slowly improved. But patient developed shortness breath, hypoxia. Concerning severe babesiosis induced ARDS, chest CT angiogram ordered showed no evidence pulmonary embolism but mild interstitial edema. 2D Echo normal left ventricular systolic function diastolic dysfunction. IV Lasix, symptoms improved CXR on 6 edema resolved.In following days, continued receive treatment babesiosis, parasitemia cleared Hgb 6.7 transfusion remained 7.9 g/dL discharge. 5 days after discharge, patient's increased 9 g/dL. month 12g/dL transaminase returned normal. DISCUSSION: ARDS life-threatening condition characterized hypoxemia due gas exchange failure. Though uncommon, diseases could present ARDS. Moreover, toxicity has also been linked acute lung injury, making correct diagnosis challenging. Early recognition intervention led favorable outcome. CONCLUSIONS: an early onset initiation usually resolves supportive treatment. REFERENCE #1: Autoimmune babesiosis.Roshni Narurkar, Aleksandra Mamorska-Dyga, John C. Nelson Delong Liu.Biomarker Research (2017) 5:14. #2: Yousef Nassar, Seth Richter. Presenting as Liver Failure. Rep Gastroenterol 2017;11:769–773. #3: Boustani MR, Lepore TJ, Gelfand JA, Lazarus DS. failure in patients treated Am J Respir Crit Care Med. 1994 Jun;149(6):1689-91. doi: 10.1164/ajrccm.149.6.8004331.PMID: 8004331 Review. DISCLOSURES: No relevant relationships Heather Bernstein, source=Web Response ALKA FARMER, CUIPING LI, Vinay Nakhate, source=Admin input kiritkumar parmar, Lin Zheng,