Post‐Malaria Neurological Syndrome: A Case Report and Review of the Literature: Table 1

Abstract

Infection with Plasmodium falciparum is known to cause several neurological complications. The most deleterious is cerebral malaria, carrying a mortality of 10–50% in treated patients. 1 Rarely, patients can experience a neurological syndrome following successful treatment, including delayed onset cerebellar ataxia (DCA), 2–4 acute disseminated encephalomyelitis (ADEM), and acute inflammatory demyelinating polyneuropathy (AIDP). 5–9 In 1994, a study from Vietnam was the first to describe a distinctly unique post‐infectious syndrome, the post‐malaria neurological syndrome (PMNS). 10 The paper defined PMNS as: patients with symptomatic malaria infection (initial blood smear positive for asexual forms of the parasite), whose parasites have cleared from the peripheral blood and, in cerebral cases, had recovered consciousness fully, who developed neurological or psychiatric symptoms within 2 months of acute illness. 10 This case series described 22 patients with various signs and symptoms of encephalopathy after severe P. falciparum infection. Since then, 13 additional cases of PMNS have been reported. Herein we describe the first case occurring in the New World, review the cases of PMNS previously reported, and aim to better distinguish PMNS from other neurological complications occurring after recovery from malaria. A 42‐year‐old healthy Caucasian man presented to a community hospital with a 4‐day history of fever, chills, malaise, myalgias, and headache. Two weeks before, he had returned from a 1‐week trip to the Dominican Republic, for which he took no malaria prophylaxis. A blood smear revealed the presence of Plasmodium falciparum ring forms with a parasitemia level of 1%. He was treated with a single dose of oral mefloquine (1,250 mg). On hospital day 2, blood smear revealed 23% parasitemia. He received meperidine for pain and subsequently had a single episode of possible seizure activity. He was transferred to VCU Medical Center on hospital day 4 at which time his parasitemia had decreased to … Corresponding Author: J. Daniel Markley, DO, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA 23298‐0019. E‐mail: jdmarkley{at}mcvhvcu.edu