Rare Complications of Vivax Malaria

Abstract Malaria is a common tropical fever encountered in India amongst 15–16 million people with 20,000 deaths annually (WHO, SEARO). It may be complicated by shock, respiratory failure, and MODS leading to increased morbidity and mortality.Rarer complications such as splenic infarcts, splenic abscess, and rupture are also observed and herein we report one such case of a splenic infarct in malaria. An 18-year-old male had fever with chills for the past 5–6 days for which he took some oral and intravenous (IV) medications but had no relief in symptoms. Due to persistent fever and recurrent nausea with decreased oral appetite, the patient was admitted. At initial presentation, the patient had stable vitals except for the temperature of 104F. Relevant investigations revealed MP positive for Plasmodium vivax both serologically and on smear examination. G-6PD was sufficient, so the patient was started on antimalarials. The patient improved symptomatically with resolution in fever and nausea, so ongoing medications were continued. However, on day 3, since admission, the patient complained of sudden onset and severe left upper abdominal pain. On clinical examination, marked tenderness was noted in the left hypocondriac region with splenomegaly so urgent abdominal ultrasound was ordered that revealed multiplehypo-echoic lesions in spleen. Contrast-enhanced computed tomography TRIPLE phase of the abdomen was ordered for better evaluation that revealed multiple wedge-shaped infarcts in the spleen. Hence, a diagnosis of splenic infarcts was made. IV Fluids were upscaled. For symptomatic relief, analgesics and proper hydration were ensured. Close monitoring was continued and patient was finally discharged under the stable conditions with radical dose of primaquine with an advice to avoid any abdominal trauma on day 7. The patient responded well to the treatment and had a complete resolution of infarcts after one and half month both clinically and radiologically. Certain rarer complications of malaria can easily be missed; however, they may prove to be fatal if not dealt with in time. Splenic infarct is one of them and although most of them will have benign course and resolve spontaneously; however, strict vigilance should be kept for the progression of symptoms and surgical interventions may be required in few of them before it turns fatal. Thus, watchful monitoring and repeat follow-ups are advised once such complications are detected.