Sudden splenic rupture in a Plasmodium vivax infected patient: A case report

Malaria is a significant public health concern in Pakistan, with Plasmodium vivax being a prevalent strain. While the disease typically follows a benign course, it can lead to severe complications including anemia, hepatic dysfunction, jaundice, acute lung injury, acute respiratory distress syndrome, pulmonary edema, shock, acute renal failure, thrombocytopenia and splenic rupture. This case report documents the presentation, diagnosis and management of a 32-year-old male patient. He was admitted with acute febrile illness and diagnosed with P. vivax infection. On the fifth day of illness he developed severe abdominal pain and hypotension, necessitating intensive care unit (ICU) admission. Labs revealed precipitous drop in hemoglobin and platelet count. Imaging studies revealed hemoperitoneum with splenic rupture. An emergency laparotomy was performed followed by splenectomy as a therapeutic intervention to manage the acute clinical crisis. Blood transfusions were administered during surgery and post-splenectomy vaccination was given. The patient's condition improved gradually and he was discharged from the hospital. This case report highlights the critical importance of early diagnosis, vigilant monitoring and timely intervention in managing severe complications associated with P. vivax infection. Prompt recognition and appropriate management are essentials to prevent morbidity and mortality in patients with severe malaria. Keywords: Plasmodium vivax, Hemoperitoneum, Complication, Splenic rupture, Splenectomy.