Maternal Babesia Infection Associated With Neonatal Extramedullary Hematopoiesis And Acute Myeloid Leukemia In Late Infancy

Background: We describe a term neonate who was exposed to maternal mid-gestation infection with Babesia microti and prenatal antimicrobic treatment with quinine, azithromycin, atovaquone, and clindamycin.Case description: The neonate was born with a "blueberry muffin rash" and was diagnosed with extramedullary hematopoiesis (EHM) after ruling out congenital infection and malignancy. At 8 months of age, he presented with M5 acute myeloid leukemia (AML) with a t(8:16)(p11;13) translocation. This translocation is described in adult patients with treatment-related AML, suggesting sensitivity of the genome to extrinsic toxicity.Conclusion: We postulate that the biologic stress and treatment of maternal babesiosis played a role in the development of the rare form of AML seen in our patient.