The cryptogenic parasite Haplosporidium pinnae has caused mass mortality of the protected endemic Mediterranean bivalve Pinna nobilis in the western Mediterranean, since the autumn of 2016. Herein, we confirm the spread of the parasite in the eastern Mediterranean, and report a mass mortality event, with > 93% average mortalities, in the coastal waters of Lesvos Island (Greece, Aegean Sea). Histopathological study of collected specimens revealed the presence of a haplosporian-like protozoon in different life cycle stages, mainly within the digestive gland of the infected Pinna nobilis, with many uni-and bi-nucleate parasite cells, plasmodia and sporocysts in the wide lumen of digestive tubules causing the collapse of epithelial cells, and apparently low host haemocyte reaction. The parasite was identified as H. pinnae by molecular methods (PCR amplification and sequencing of a part of small subunit ribosomal DNA gene, and comparison with available records in Genbank). In many sites, 100% mortality was recorded, whereas in a single site (among 13 surveyed sites) mortality was relatively low (36%), successful recruitment was observed and the parasite was not detected. The latter observation stresses the importance of possible parasite-free refugia sites. We call for continuous monitoring of the spread of the parasite and its impacts, and for urgent targeted research and actions to identify the factors affecting the parasite's virulence, investigate biotic and abiotic conditions that characterize refugia sites, and strictly protect the remaining P. nobilis populations to increase the chances for the survival of the species.