Multiple Splenic Lesions on MRI as a Radiologic Manifestation of Babesiosis

Abstract

We showcase our 79-year-old female patient from Long Island, New York, who presented to the hospital in June 2023 with daily fevers, fatigue, generalized abdominal pain, intermittent nausea, anorexia, dark urine, and dry cough. The patient has a medical history of hypothyroidism, osteoporosis, and hepatitis C that was treated in 2019, and stage 0 ductal carcinoma in situ of the breast, for which she underwent lumpectomy in 2007. Our patient was found to have anemia with a hemoglobin of 7.9g/dL (11.5 – 15.5 g/dL) and thrombocytopenia with platelets of 74,000/mm 3 (150,000 – 400,000/mm 3 ). Computed tomography (CT) abdomen and pelvis demonstrated a 1.4cm hypodense right hepatic nodule, which was concerning for possible cholangiocarcinoma. Follow-up magnetic resonance imaging (MRI) abdomen and pelvis was performed and revealed the liver lesion to be benign appearing and unchanged from previous studies done in 2020. However, post-contrast T1-weighted MRIs showed mild splenomegaly (13.2 cm) with multiple ill-de fi ned, hypoattenuating splenic lesions measuring up to 1cm ( ► Fig. 1A and B ). These splenic lesions were not visible on other sequences, including unenhanced T1-weighted, T2-weighted, and diffusion-weighted sequence. These lesions were