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Diabetic foot osteomyelitis — ABIM Board MCQ

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HardInfectious DiseaseDiabetic foot osteomyelitisABIM Board

A 69-year-old asplenic man from Massachusetts has fever, jaundice, acute kidney injury, hypoxemia, hemoglobin 6.9 g/dL, and Babesia parasitemia of 18% despite initiation of intravenous azithromycin plus atovaquone. Which additional intervention should be discussed urgently?

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Correct answer: B — Arrange red-cell exchange transfusion with hematology and transfusion medicine

The best answer is “Arrange red-cell exchange transfusion with hematology and transfusion medicine”. High-grade parasitemia together with severe hemolysis, renal dysfunction, and pulmonary compromise defines life-threatening babesiosis. IDSA recommends expert consultation and consideration of red-cell exchange transfusion in this setting, alongside effective antimicrobial therapy. The decision uses both parasite burden and organ injury rather than an absolute percentage alone. Plasma exchange, glucocorticoids, and rituximab do not rapidly remove parasitized erythrocytes.

Reference: IDSA 2020 Guideline on Babesiosis: https://www.idsociety.org/practice-guideline/babesiosis/