Dramatic post-splenectomy onset of malaria caused by latent Plasmodium vivax in a female immigrant with severe immunological anaemia.

Abstract

Immune-mediated anaemia is characterized by the production of autoantibodies against different erythrocyte antigens resulting in red blood cells being destroyed, mainly in the spleen. First-line therapy consists of immune suppression by steroids, while the second choice of treatment, in resistant or relapsed patients, is splenectomy. The World Health Organisation (WHO) World Malaria Report 2012 summarises data received from 104 malaria endemic countries and territories and updates the 2011 report. According to these latest estimates, there were about 219 million cases of malaria in 2010 and an estimated 660,000 deaths. The disease is still highly endemic in the tropics but has been completely eradicated in some temperate areas, including southern Europe, and partially eradicated in northern Africa1–3. In some malaria cases a concomitant, positive direct antiglobulin test (DAT) can increase disease severity and interfere with a correct diagnosis4. Plasmodium vivax is unique among human malarias in that erythrocyte invasion is almost entirely dependent on the red cell surface receptor, known as the Duffy blood group antigen (Fy)5. When steroids fail, the treatment of choice for immune-mediated chronic anaemia is splenectomy, although this operation can carry the risk of reactivating the infection in the case of underlying silent forms of malaria6,7.