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Kawasaki disease — USMLE Step 2 CK MCQ

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HardPediatricsKawasaki diseaseUSMLE Step 2 CK

A 72-year-old asplenic man from Massachusetts has fever, jaundice, hemoglobin 6.8 g/dL, creatinine 3.1 mg/dL and Babesia parasitemia of 18% despite antimicrobial therapy. Which additional intervention is most appropriate?

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Correct answer: E — Arrange red-cell exchange transfusion with specialist consultation

This patient has severe babesiosis with high-grade parasitemia, severe hemolytic anemia and renal compromise. IDSA advises considering red-cell exchange transfusion when parasitemia exceeds 10% or severe hemolysis or organ failure is present, with hematology, transfusion-medicine and infectious-disease input. Exchange accompanies—not replaces—appropriate combination antimicrobials. Glucocorticoids do not treat parasitic hemolysis, splenectomy would worsen pathogen clearance, and ongoing visible parasitemia is clinically meaningful.

Reference: IDSA 2020 guideline on diagnosis and management of babesiosis. https://www.idsociety.org/practice-guideline/babesiosis/