344. Post Malaria Neurological Syndrome: A Rare Complication of Malaria

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BackgroundPost malaria neurological syndrome (PMNS) is a rare neurological complication that can occur after recovery from malaria, usually following severe Plasmodium falciparum malaria. A total of 43 cases have been previously reported in the literature.MethodsWe report a patient with neurological symptoms following 1 month of clinical and microbiological resolution of severe falciparum malaria following treatment consistent with PMNS.ResultsA 24-year-old male presented with fever, confusion, dysarthria, and grand mal seizure. His recent medical history was significant for severe falciparum malaria with multiorgan dysfunction, including acute kidney injury after being noncompliant with antimalarial prophylaxis while working for the Peace Corps in Togo prior to falling ill. He fully recovered but still required dialysis, and returned to the United States. He presented to the hospital 1 month after his initial malaria infection. On physical examination, the patient was febrile to 38.9°C, lethargic and responsive only to painful stimuli. Signs of meningismus were absent. Computed tomography of head, abdomen and thorax were unrevealing. Magnetic resonance imaging of the brain revealed a nonspecific focus of signal abnormality in right internal capsule. Cerebral spinal fluid (CSF) analysis revealed WBC of 75/μL, with lymphocytic pleocytosis and elevated protein of 65 mg/dL. CSF bacterial and viral polymerase chain reaction pane and cryptococcal antigen were negative. CSF VDRL was nonreactive. HIV antigen/antibody serology was negative. Blood, CSF, and urine cultures were all negative for growth. Two malaria smears were negative. Initially, he was started on broad spectrum antibiotics, Acyclovir and Coartem which were discontinued following negative laboratory results, and a steroid taper was initiated. His mental status began improving on the second day of the initiation of the steroid taper, and he fully recovered by day 5 of steroid therapy.ConclusionIn patient with recent medical history of malaria who presents with neuropsychiatric symptoms, clinicians must have a high index of suspicion for PMNS.Figure 1.MRI of brain showing nonspecific focus of signal abnormality in the posterior limb of the right internal capsule.Disclosures All authors: No reported disclosures.